District Health Action Plan

2010-2011

District Health Society Muzaffarpur Foreword

The National Rural Health Mission envisages the planning process to be participatory and decentralized starting with the village. It seeks to empower the community by placing the health of the people in their own hands and determine the ways they would like to improve their health. This is the only way to ensure that health plans are need based. The state would play a facilitator’s role. NRHM was launched in April 2005. Department of Health, Government of Haryana is implementing the NRHM in right earnest. The State Health Society took a number of enabling actions. This created an environment conducive for decentralized planning by the district. The District Action Plan is the most important aspect of the planning process as the Government of India and the state government would monitor the progress of implementation district wise. The district is also the key administrative unit for most of the development activities. This plan is based on health needs of the district. After a thorough situational analysis of district health scenario this document has been prepared. In the plan, it is addressing health care needs of rural poor especially women and children, the teams have analyzed the coverage of poor women and children with preventive and promotive interventions, barriers in access to health care and spread of human resources catering health needs in the district. The focus has also been given on current availability of health care infrastructure in pubic/NGO/private sector, availability of wide range of providers. This DHAP has been evolved through a participatory and consultative process, wherein community and other stakeholders have participated and ascertained their specific health needs in villages, problems in accessing health services, especially poor women and children at local level. I need to congratulate the department of Health and Family Welfare and State Health Society of Bihar for their dynamic leadership of the health sector reform programme and we look forward to a rigorous and analytic documentation of their experiences so that we can learn from them and replicate successful strategies. I also appreciate their decision to invite consultants (NHSRC/ PHRN) to facilitate our DHS regarding preparation the DHAP. The proposed location of HSCs, PHCs and its service area reorganized with the consent of ANM, AWW, male health worker and participation of community has finalized in the block level meeting.

Muzaffarpur/DHAP 10-11/Page: 2

I am sure that this excellent report will galvanize the leaders and administrators of the primary health care system in the district, enabling them to go into details of implementation based on lessons drawn from this study.

(Anand Kishore) (District Magistrate) Muzaffarpur

Muzaffarpur/DHAP 10-11/Page: 3

Acknowledgment

The Government of India has resolved to launch the National Rural Health Mission in April 2005 to carry out necessary architectural correction in the basic health care delivery system. The Goal of the Mission is to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children. District Action Plans is the most important unit of the planning process as the Government of India and the state government would monitor the progress of implementation district wise. The district is also the key administrative unit for most of the development activities. The District Action Plan adopts a synergistic approach by relating health to determinants of good health viz. segments of nutrition, sanitation, hygiene and safe drinking water. The Plan of Action includes increasing public expenditure on health, reducing regional imbalance in health infrastructure, pooling resources, integration of organizational structures, optimization of health manpower, decentralization and district management of health programmes, community participation and ownership of assets, induction of management and financial personnel into district health system, and operationalizing community health centers into functional hospitals meeting Indian Public Health Standards in each Block of the Country. District Action Plan has vision to reduce the Maternal Mortality Rate (MMR), Infant Mortality Rate (IMR) and the Total Fertility Rate (TFR) in the district within the period of the National Rural Health Mission. In addition to improving the maternal and child health, District Health Action plan has also emphasized on other thrusts area like; Malaria, Tuberculosis, Leprosy, Iodine Deficiency, Blindness, AID/HIV, RIT/STI, Acute Diarrhea, Typhoid and other common communicable and non-communicable diseases. Under the National Rural Health Mission this District Health Action Plan of Muzaffarpur district has been prepared. From this, the situational analysis the study proceeds to make recommendations towards a policy on workforce management, with emphasis on organizational, motivational and capability building aspects. It recommends on how existing resources of manpower and materials can be optimally utilized and critical gaps identified and addressed. It looks at how the facilities at different levels can be structured and reorganized.

Muzaffarpur/DHAP 10-11/Page: 4

I am grateful to the state level consultants ( NHSRC/PHRN), ACMO, MOICs, member of DHS,Block Health Managers and ANMs,ASHAs and AWWs from their excellent effort we may be able to make this District Health Action Plan of Muzaffarpur District. I hope that this District Health Action Plan will fulfill the intended purpose.

(Dr. Arjun Pd. Singh) Civil Surgeon Muzaffarpur

Muzaffarpur/DHAP 10-11/Page: 5

Chapter-1

Introduction

1.1 Background

Keeping in view health as major concern in the process of economic and social development revitalization of health mechanism has long been recognized. In order to galvanize the various components of health system, National Rural Health Mission (NRHM) has been launched by Government of India with the objective to provide effective health care to rural population throughout the country with special focus on 18 states which have weak public health indicators and/or weak infrastructure. The mission aims to expedite achievements of policy goals by facilitating enhanced access and utilization of quality health services, with an emphasis on addressing equity and gender dimension. The specific objectives of the mission are:

§ Reduction in child and maternal mortality § Universal access to services for food and nutrition, sanitation and hygiene, safe drinking water § Emphasis on services addressing women and child health; and universal immunization § Prevention and control of communicable and non-communicable diseases, including locally endemic diseases § Access to integrated comprehensive primary health care § Revitalization local health traditions and mainstreaming of AYUSH § Population stabilization One of the main approaches of NRHM is to communities, which will entail transfer of funds, functions and functionaries to Panchayati Raj Institutions (PRIs) and also greater engagement of Rogi Kalyan Samiti (RKS). Improved management through capacity development is also suggested. Innovations in human resource management are one of the major challenges in making health services effectively available to the rural/tribal population. Thus, NRHM proposes ensured availability of locally resident health workers, multi-skilling of health workers and doctors and integration with private sector so as to optimally use human resources. Besides, the mission aims for making untied funds available at different levels of health care delivery system. Core strategies of mission include decentralized public health management. This is supposed to be realized by implementation of District Health Action Plans (DHAPs) formulated through a participatory and bottom up planning process. DHAP enable village, block, district and state Muzaffarpur/DHAP 10-11/Page: 6 level to identify the gaps and constraints to improve services in regard to access, demand and quality of health care. In view with attainment of the objectives of NRHM, DHAP has been envisioned to be the principle instrument for planning, implementation and monitoring, formulated through a participatory and bottom to up planning process. NRHM-DHAP is anticipated as the cornerstone of all strategies and activities in the district. For effective programme implementation NRHM adopts a synergistic approach as a key strategy for community based planning by relating health and diseases to other determinants of good health such as safe drinking water, hygiene and sanitation. Implicit in this approach is the need for situation analysis, stakeholder involvement in action planning, community mobilization, inter-sectoral convergence, partnership with Non Government Organizations (NGOs) and private sector, and increased local monitoring. The planning process demands stocktaking, followed by planning of actions by involving program functionaries and community representatives at district level.

Stakeholders in Process

q Members of State and District Health Missions

q District and Block level programme managers, Medical Officers.

q State Programme Management Unit, District Programme Management Unit and Block Program Management Unit Staff

q Members of NGOs and civil society groups

q Support Organisation – PHRN and NHSRC Besides above referred groups, this document will also be found useful by health managers, academicians, faculty from training institutes and people engaged in programme implementation and monitoring and evaluation.

1.2 Objectives of the Process

The aim of this whole process is to prepare NRHM – DHAP based on the framework provided by NRHM-Ministry of Health and Family Welfare (MoHFW). Specific objectives of the process are:

Muzaffarpur/DHAP 10-11/Page: 7

ð To focus on critical health issues and concerns specifically among the most disadvantaged and under-served groups and attain a consensus on feasible solutions ð To identify performance gaps in existing health infrastructure and find out mechanism to fight the challenges ð Lay emphasis on concept of inter-sectoral convergence by actively engaging a wide range of stakeholders from the community as well as different public and private sectors in the planning process ð To identify priorities at the grassroots and curve out roles and responsibilities at block level in designing of DHAPs for need based implementation of NRHM

1.3 Process of Plan Development

1.3.1 Preliminary Phase

The preliminary stage of the planning comprised of review of available literature and reports. Following this the research strategies, techniques and design of assessment tools were finalized. As a preparatory exercise for the formulation of DHAP secondary Health data were complied to perform a situational analysis.

1.3.2 Main Phase – Horizontal Integration of Vertical Programmes

The Government of the State of Bihar is engaged in the process of re – assessing the public healthcare system to arrive at policy options for developing and harnessing the available human resources to make impact on the health status of the people. As parts of this effort present study attempts to address the following three questions:

1. How adequate are the existing human and material resources at various levels of care (namely from sub – center level to district hospital level) in the state; and how optimally have they been deployed?

2. What factors contribute to or hinder the performance of the personnel in position at various levels of care?

Muzaffarpur/DHAP 10-11/Page: 8

3. What structural features of the health care system as it has evolved affect its utilization and the effectiveness?

With this in view the study proceeds to make recommendation towards workforce management with emphasis on organizational, motivational and capacity building aspects. It recommends on how existing resources of manpower and materials can be optimally utilized and critical gaps identified and addressed. It also commends at how the facilities at different levels can be structured and organized.

The study used a number of primary data components which includes collecting data from field through situation analysis format of facilities that was applied on all HSCs and PHCs of Vaishali district. In addition, a number of field visits and focal group discussions, interviews with senior officials, Facility Survey were also conducted. All the draft recommendations on workforce management and rationalization of services were then discussed with employees and their associations, the officers of the state, district and block level, the medical profession and professional bodies and civil society. Based on these discussions the study group clarified and revised its recommendation and final report was finalized.

Government of India has launched National Rural Health Mission, which aims to integrate all the rural health services and to develop a sector based approach with effective inter-sectoral as well as intra-sectoral coordination. To translate this into reality, concrete planning in terms of improving the service situation is envisaged as well as developing adequate capacities to provide those services. This includes health infrastructure, facilities, equipments and adequately skilled and placed manpower. District has been identified as the basic coordination unit for planning and administration, where it has been conceived that an effective coordination is envisaged to be possible.

This Integrated Health Plan document of Muzaffarpur district has been prepared on the said context.

1.3.3 Preparation of DHAP The Plan has been prepared as a joint effort under the chairmanship of District Magistrate of the district, Civil Surgeon, ACMO(Nodal officer for DHAP formulation), all program officers and Muzaffarpur/DHAP 10-11/Page: 9

NHSRC/PHRN as well as the MOICs, Block Health Managers, ANMs, as a result of a participatory processes as detailed below. After completion the DHAP, a meeting is organized by Civil Surgeon with all MOIC of the block and all programme officer. Then discussed and displayed prepared DHAP. If any comment has came from participants it has added then finalized. The field staffs of the department too have played a significant role. District officials have provided technical assistance in estimation and drafting of various components of this plan. After a thorough situational analysis of district health scenario this document has been prepared. In the plan, it is addressing health care needs of rural poor especially women and children, the teams have analyzed the coverage of poor women and children with preventive and promotive interventions, barriers in access to health care and spread of human resources catering health needs in the district. The focus has also been given on current availability of health care infrastructure in pubic/NGO/private sector, availability of wide range of providers. This DHAP has been evolved through a participatory and consultative process, wherein community and other stakeholders have participated and ascertained their specific health needs in villages, problems in accessing health services, especially poor women and children at local level.

Muzaffarpur/DHAP 10-11/Page: 10

Relevance of DHAPs — Addressing local specificities — Epidemiological patterns, socio-economic conditions, cultural practices and systemic constraints — Facilitating Convergence — Inclusion of health determinants such as water, nutrition and environment — District as the point of convergence for implementation for various policies, schemes and programmes of different department — Efficient allocation and increased utilization of financial resources at the district level

Relevance of DHAPs — Improving performance through decentralization — Transition from budget oriented plans to outcome oriented plans — Opportunity to incorporate inputs and insights from the grass-roots to above — Leads to improved capacity of the health system to facilitate planning, implementation and monitoring — Public participation and ownership — Opportunity to incorporate issues raised in various community platforms such as VHSC, RKS, Gram Panchayat — Increased accountability

Muzaffarpur/DHAP 10-11/Page: 11

Process adopted at all level:

State level: 1. Fast track training on DHAP at state level. 2. Collection of Data through various sources 3. Understanding Situation & its analysis 4. Assessing Gap District level: 1. conduction of district level workshop with Key Medical staff, Health Managers, civil society, Line department On DHAP at district level 2. Collection of Data through various sources 3. Understanding Situation & its analysis 4. Assessing Gap 5. Selection of nodal officers for assisting for BHAP preparation 6. District level meeting to compile information 7. 2nd round workshops on feed back for final draft submission

Block level: 1. Block level consultation workshop with ANM,civil society and block level line department 2. Block level meetings with ANM to discuss on format to be fill for situation analysis 3. Organizing meeting with key medical staff , civil society and line department to add any information in BHAP 4. Sharing of final draft with all through organizing meeting at PHC

Finally all BHAP will be submitted by respective PHC to DHS before the dead line and ultimately DHS with the support of line department in leadership of ACMO will incorporate the information from BHAP and prepare DHAP of the district.

Muzaffarpur/DHAP 10-11/Page: 12

Chapter 2 District Profile

History

Muzaffarpur district, ‘The Land Of Leechi’ was created in 1875 for the sake of administrative convenience by splitting up the earlier district of Tirhut. The present district of Muzaffarpur came to its existence in the 18th century and named after Muzaffar Khan, an Amil (Revenue Officer) under British Dynasty. Purbi Champaran and Sitamarhi districts on North, on the South Vaishali and Saran districts, on the East Darbhanga and Samastipur districts and on the West Saran and Gopalganj districts surround Muzaffarpur. Now it has won international encomiums for its delicious Shahi Leechi and China Leechi. It is, of course impossible to trace back the history of this region to its earliest origins, but we can trace back it’s stream of strong heritage a very long way through the ancient Indian epic Ramayan, which still bears a significant role in Indian civilization. To initiate with the Legend, Rajarshi Janak was ruling Videha, the mythological name of this entire region including eastern Nepal and northern Bihar. Sitamarhi, a place in this region, bears a value of sacred Hindu belief where, Seeta (other name Vaidehi: The Princes of Videha) sprang to life out of an earthen pot while Rajarshi Janak was tilling the land. The recorded history of the district dates back to the rise of the Vrijjan Republic. The center of political power also shifted from Mithila to Vaishali. The Vrijjan Republic was a confederation of eight clans of which the Licchavis were the most powerful and influential. Even the powerful kingdom of Magadh had to conclude matrimonial alliances in 519 B.C. with the neighboring estates of the Licchavis. Ajatshatru invaded Vaishali and extended his sway over Tirhut. It was at this time that Patliputra (the modern Patna) was founded at the village Patali on the banks of the sacred river Ganga and Ajatshatru built an invincible fortress to keep vigil over the Licchavis on the other side of the river. Ambarati, 40 Kms from Muzaffarpur is believed to be the village home of Amrapali, the famous Royal court dancer of Vaishali.

Muzaffarpur/DHAP 10-11/Page: 13

Vaishali, a center of religious renaissance, Baso Kund, the birth place of Mahavir, the 24th Jain Tirthankar and a contemporary of Lord Buddha continue to attract visitors from across the international boarders. From the visit of the Hieuen Tsang’s till the rise of the Pala dynasty, Muzaffarpur was under the control of Maharaja Harsha Vardhan, a powerful sovereign of North India. After 647 A.D. the district passed on to the local chiefs. In the 8th century A.D. the Pala kings continued to have their hold over Tirhut until 1019 A.D. Chedi kings of Central India also exercised their influence over Tirhut till they were replaced by the rulers of the Sena dynasty towards the close of the 11the century. Between 1211 & 1226, Ghais-u-ddin Iwaz, the ruler of Bengal, was the first Muslim invader of Tirhut. He, however, could not succeed in conquering the kingdom but extorted tributes. It was in 1323 that Ghiyasuddin Tughlaq established his control over the district. The history of Muzaffarpur will remain incomplete without a reference to the Simraon dynasty (in the north-east part of Champaran) and its founder Nanyupa Deva who extended his power over the whole of Mithila and Nepal. During the regime of Harasimha Deva, the last king of the dynasty, Tughlaq Shah invaded Tirhut in 1323 and gained control over the territory. Tughlaq Shah handed over the management of Tirhut to Kameshwar Thakur. Thus, the sovereign power of Tirhut passed from the Hindu chiefs to the Muslims but the Hindu chief continued to enjoy complete autonomy uninterruptedly. Towards the close of the 14th century the whole of North Bihar including Tirhut passed on to the kings of Jaunpur and remained under their control for nearly a century until Sikandar Lodi of Delhi defeated the king of Jaunpur. Meanwhile, Hussain Shah, the Nawab of Bengal had become so powerful that he exercised his control over large tracts including Tirhut. The emperor of Delhi advanced against Hussain Shah in 1499 and got control over Tirhut after defeating its Raja. The power of the Nawabs of Bengal began to wane and with the decline and fall of Mahood Shah, north Bihar including Tirhut formed a part of the mighty Mughal Empire. Though Muzaffarpur with the entire north Bihar had been annexed yet the petty powerful chieftains continued to exercise effective Muzaffarpur/DHAP 10-11/Page: 14 control over this area till the days of Daud Khan, the Nawab of Bengal. Daud Khan had his stronghold at Patna and Hajipur and after his fall a separate Subah of Bihar was constituted under the Mughal dynasty and Tirhut formed a part of it. The victory of East India Company in 1764 at the battle of Buxar gave them control over whole of Bihar and they succeeded in subduing the entire district. The success of the insurgent at Delhi in 1857 caused grave concern to the English inhabitants in this district and revolutionary fervor began to permeate the entire district. Muzaffarpur played its role and was the site of the famous bomb case of 1908. The young Bengali revolutionary, Khudi Ram Bose, a boy of barely 18 years was hanged for throwing the bomb at the carriage of Pringle Kennedy who was actually mistaken for Kingsford, the District Judge of Muzaffarpur. After independence, a memorial to this young revolutionary patriot was constructed at Muzaffrapur, which still stands. The political awakening in the country after the First World War stimulated nationalist movement in Muzaffarpur district also. The visit of Mahatma Gandhi to Muzaffarpur district in December 1920 and again in January 1927 had tremendous political effect in arousing the latent feelings of the people and the district continued to play a prominent role in the country’s struggle for freedom. Muzaffarpur played a very significant role in the history of North-Eastern India. The peculiarity of Muzaffarpur in Indian civilization arises out of its position on the frontier line between two most vibrant spiritual influences and most significantly, to this day, it is a meeting place of Hindu and Islamic culture and thoughts. All sorts of modified institutions, representing mutual assimilation, rise along the boarder line. It has undoubtedly been this highly diversified element within her boundaries that has so often made Muzaffarpur the birthplace of towering geniuses. Geographical Location

The District is located at 25O 54’ to 26O 23’ North latitude and 84O 53’ to 85O 45’ east longitude .This district is one of the oldest and largest trade centers in the entire state. it

Muzaffarpur/DHAP 10-11/Page: 15 shares boundaries with East Champaran, Sitamarhi, Vaishali, Saran, Darbhanga, Samastipur and Gopalganj district covering an area of 3,172 sq km having total population is 3 million.

Boundary

District Sitamarhi & East Champaran orth South District Vaishali & Saran East District Darbhanga & Samastipur West District Saran & Gopalganj

Location Latitude North 25O 54’ to 26O 23’ Longitude East 84O 53’ to 85O 45’ Height from sea 170 ' level

The Bagmati, Gandak, and Burhi Gandak are the important rivers. Main sources of economy are agriculture and industries. Paddy, maize, wheat, and lentils are some of the important crops. Muzaffarpur is famous for litchis and mangoes. There are sugar factories at Motipur, a thermal power station at Kanti, a wagon factory at Muzaffarpur, and pharmaceuticals at Narayanpur. This district exhibits a rare assimilation of Hindu and Islamic culture and thoughts. Much frequented tourist spots such as Hajipur, Sonepur, and Vaishali are near Muzzafarpur. The nearest airport is at Patna at a distance of 72 km.

District Health Administrative Setup There are two sub divisions and 16 Blocks in the District. The District has 1811 revenue villages and 387 Gram panchayats. A few of the newly created Blocks are still in the formation process. The newly elected Panchayati Raj is enthusiastic to play important role in the District.

Muzaffarpur/DHAP 10-11/Page: 16

Governing Body DHS District Health Society,Muzaffarpur Bihar

DM Cum Chairman

CS Cum Secretary

ACMO

DS Program Officers Sadar Hospital

MOI/C AT BHM

BPHC

DPM

APHC HSC

Muzaffarpur/DHAP 10-11/Page: 17

MUZAFFARPUR AT A GLANCE Muzaffarpur east and west are the two subdivision and there boundary represent two Lok Sabha (Parliamentary) – 1. Muzaffarpur 2. Vaishali. PHC Community Development Blocks Towns

AURAI AURAI BANDRA BANDRA BOCHHA BOCHHA GAIGHAT GAIGHAT KANTI KANTI KANTI KATRA KATRA KURHNI KURHNI MINAPUR MINAPUR MOTIPUR MOTIPUR MOTIPUR MURAUL MURAUL MUSAHRI® MUSAHRI® PAROO PAROO SAHEBGANJ SAHEBGANJ SAKRA (RH) SAKRA SARAIYA SARAIYA Muzaffarpur sadar Muzaffarpur ( District HQ) Muzaffarpur hospital

Geographical Information Geographical Area 317591 Ha. Cultivated Area 247721 Ha. Non – Cultivated Area 59270 Ha. Net Shown Area 219963 Ha. Slain Land 5230 Ha. Irrigation Area 82964 Ha. Horticulture Area 16667 Ha.

Important River 1 BAGMATI 2 GANDAK 3 BURHI GANDAK 4 LAKHANDEYEE

Muzaffarpur/DHAP 10-11/Page: 18

Demographic Data CONTENTS 2001 1991 1981 1971 1961 Total Population 3743836 2953903 2357388 4840681 4118398 Male Population 1941480 1551637 1201064 2434111 2011539 Female Population 1802356 1402266 1156324 2406570 2106859 Urban Population 274965 190416 253962 188825 Male Female Ratio 1000:928 1000:904 1000:945 1000:953 1000:994 Sc Population 594577 464362 368176 ------St Population 3472 1156 648 ------Sc % 16.7% 15.72 % 15.62 % ------St% 0.1% 0.04% 0.03% ------Literate 1456901 851995 571843 ------Male Literate 943928 603298 418905 ------Female Literate 512973 248697 152938 ------Male Literacy Rate 60.19% 48.44% 34.90% ------Female Literacy Rate 35.20% 22.33% 13.20% ------Population Density 1180 PER Sq 931 PER Sq 743 PER Sq ------Km Km Km Note : Population Of Sitamarhi & Vaishali District Included In 1971 & 1961 As It Was The Part Of Muzaffarpur District

COMPARATIVE POPULATION DATA ( 2001 CENSUS) Basic Data India Bihar Muzaffarpur Population 1027015247 82878796 3743836 Density PER Sq Km 324 880 1180 Sex- Ratio 933 921 920 Literacy % Total 65.38 47.53 48.15 Male 75.85 60.32 60.19 Female 54.16 33.57 35.20

2.1 SOCIO-ECONOMIC PROFILE Social: · Muzaffarpur district has a strong hold of tradition with a high value placed on joint family, kinship, caste and community. · The villages of Muzaffarpur have old social hierarchies and caste equations still shape the local development. The society is feudal and caste ridden. The literacy rate in (7 year and above) male is 60.2% and 35.2% in female as per the DLHS-3 has only 35.2%. whereas Educational Institution in this district is as below: Institution No.

Muzaffarpur/DHAP 10-11/Page: 19

PRIMARY & BASIC SCHOOL 2225 MIDDLE SCHOOL 397 HIGH SCHOOL 101 PROJECT SCHOOL 6 [10+2] HIGH SCHOOL 6 DEGREE COLLEGE 15 POST GRADUATE COLLEGE 4 · 15.7%(DLHS-3) of the population belongs to SC and 0.04%%(DLHS-3) to ST. There are at least 13% percent villages where the SC population is more than 40%. Some of the most backward communities are Mushahar, Turha, Mallah and Dome.

Economic: · The main occupation of the people in Muzaffarpur is Agriculture, Fisheries and daily wage labour. · Almost 20% of the youth population migrates in search of jobs to the metropolitan cities like Delhi,Punjab,Kolkata, Mumbai and Haryana etc. · The main crops are Wheat, Paddy, Pulses, Oilseeds, Lichi and Mango. · Sugarcane and Tobacco are the major cash crop of the community .

Demographic scenario of Muzaffarpur district. According to Census of India 2001: · The size of population of Vaishali district is above 3743836, comprising 5 % population of Bihar. · Very high density of population (1180) which is still rising · Decadal population growth rate of 26.39% as against 28.43% of the state as a whole. Thus the decadal growth rate of the district is slightly less than that of the state. · Sex ratio of the population is 920 females per thousand males which is almost same as the sex ratio of the state. It is difficult to interpret the deficit of 80 females per thousand males in the district despite outward migration, predominantly of males in the working ages. A plausible explanation seems to be

Muzaffarpur/DHAP 10-11/Page: 20

that over the years male population has benefited more from the epidemiological transition than the female population. · Only 6.9% of the population resides in the urban area, and the rest lives in the rural areas. Based on these statistics one can say that Muzaffarpur district lacks urbanization and industrialization. As elsewhere in Bihar, Muzaffarpur suffers from lack of infrastructure facilities, lack of connectivity, and lack of social development and most people depend on small size agricultural land. Agricultural productivity is further affected adversely by recurrent floods and droughts (World Bank, 2005). Rainfall and Flood and draught Situation The district receives medium to heavy rainfall (average rainfall 1161 mm), and faces condition of severe flood. In the year 2007 the flood condition was so bad that almost 145 gram panchayats and 583 villages got marooned. Katra,Aurai,Bandra,Muraul and Bochha blocks were the worst affected blocks. According to the estimates of National Disaster Management Department, in the year 2007, 1,64,237 people were directly affected by the floods. Crops were damaged, and there was irreparable damage to property and huge loss of lives. The economic loss due to floods this year amounts to Rs. 65 crore of crop loss, Rs. 25 crore of housing loss and Rs. 27 crore of public property loss. The district has poor drainage system and nearly 4.5% of the area is water logged. The district has a total geographical area of 317591ha. 247721 Ha. area comes under cultivated land Whereas 59270 ha. Of land comes under non cultivated Land , with no forest cover. That is 78% of the land is agricultural in this district and nearly 33% of the cultivated land is irrigated. Muzaffarpur district is also affected by droughts. Cycles of floods and droughts severally affect the food production and food distribution system, and lead to distressful situation for most people.

2.3 HEALTH PROFILE Muzaffarpur/DHAP 10-11/Page: 21

General Status of health in Muzaffarpur district In a study of 513 districts of the country (Jansankhya Sthirata Kosh", www.jsk.gov.in) in terms of overall rank in health it was found that Muzaffarpur district ranks 460 though on the basis of under-five mortality it ranked 274. whereas a study on Composite Index was done by the same agency in all districts of Bihar Muzaffarpur stood 6 rank in its State.

Filaria, Malaria, Dengue, Kala-azar, skin diseases, and Tuberculosis are some of the most common diseases in Muzaffarpur district. Hepatitis, Diarrhea, Typhoid, Blindness and Leprosy are other high prevalence diseases. Kala-azar is an endemic problem in Bihar. As per DLHS 2002-2004 the prevalence percentage of kala-azar is 11.4% and TB is 4.3%. The overall prevalence of tuberculosis in India is 544 per 100,000 populations while in Muzaffarpur it is reported to be close to 618 per 100,000 (RCH, Round 2). Table-: Infant Mortality Rate (IMR) and Child Mortality Rate (CMR) Indicators Rural Urban Total M F T M F T M F T Infant 41 57 50 34 36 35 40 56 48 Muzaffarpur Mortality 56 60 58 41 42 42 55 58 57 Bihar Rate Child 54 65 59 37 43 40 53 65 59 Muzaffarpur Mortality 59 69 64 42 46 44 57 66 62 Bihar Rate Source: Population Foundation of India May 2008 The table gives the estimates of infant mortality rates and child mortality rates of Muzaffarpur and compared with the data of Bihar. IMR in rural areas (50) are higher

Muzaffarpur/DHAP 10-11/Page: 22 than the urban areas (35). Also CMR in rural areas (59) is higher than in urban areas (40). The differential ratio of infant mortality rate of male/female is 0.7 and rural/urban is 1.4. The differential ratio of child mortality rate of male/female is 0.8 and rural/urban is 1.5. 2.3.1 Health Status and Burden Of Diseases

Table. Case Fatality Rate S.No. 2007 2008 Disease Case Death Case Death 1 Gastroenteritis 67 6 166 0 2 Diarrhea / 1515 5 882 2 Dysentery 3 Cholera 0 0 0 0 4 Meningitis 0 0 0 0 5 Jaundice 0 0 0 0 6 Tetanus 0 0 0 0 7 Kala-azar 3275 6 2632 3 8 Malaria 0 0 0 0 9 Measles 0 0 0 0

As per the DLHS2 &3 Muzaffarpur showing this figure regarding health

Table . Morbidity Due To Major Disease S.No. Disease 2007 2008 1 Kala-azar 3275 2632 2 T.B. (NSP) 997 575 Muzaffarpur/DHAP 10-11/Page: 23

3 Leprosy (PR/10000) 1.15 1.30

Table . Basic Health Status Indicators Of Muzaffarpur District

Indicators Muzaffarpur Bihar Couple Protection Rate (CPR) 33% Crude Death Rate (CDR) NA 8.1 Crude Birth Rate 31.9 30.4 Dacadal growth rate 26.7(1991-01)(DLHS- 3) Infant Mortality Rate 61 61 Maternal Mortality Rate 371 371 Total Fertility Rate (TFR) 4.6 4 Under 5 Mortality Rate NA 85 Still Birth Rate NA NA Abortion rate NA NA

Table . Denoting Priority Areas in each of the Block Block Hard to Reach area Katra Whole villages Aurai Most of the villages Bandra Most of the villages

Note: During raining season i.e. From mid June to September almost 80 percent of the villages become hard to reach area.

2.3.2 Public Health Care Delivery System: Organisational Structure and Infrastructuretable Health Care Institutions in the District

S.No. Type of Institutions Number No. of Beds* 1 District Hospital 1 318

2 Referal 1 30

3 Block PHCs 16 96

4 APHCs (Old) 43 60

5 APHCs (New) 14 0

6 Sub-centres (Old) 473 0

7 Sub Centre (New) 5 0

Muzaffarpur/DHAP 10-11/Page: 24

8 Anganwadi Centres 3211 - 9 Others (Pvt. Facility accreditated) 5 70

Map showing PHC and APHC

Muzaffarpur/DHAP 10-11/Page: 25

Gynecologist surgeon Pediatrician Anesthetics

Map showing specialist doctors position blockwise

2.5 NON-GOVERNMENT ORGANIZATIONS (NGO) IN THE DISTRICT Adithi, Nirdesh, Ramani, AGSC, PGVSS, Center Direct, WDC, Seva Kendra, Mission of charity, IDF, Nidan, GJKP etc

Muzaffarpur/DHAP 10-11/Page: 26

Chapter 3 Situation Analysis

In the present situational analysis of the blocks of district Muzaffrapur the vital statistics or the indicators that measure aspects of health/ life such as number of births, deaths, fertility etc. have been referred from census 2001, report of DHS office, Muzaffrapur and various websites as well as other sources. These indicators help in pointing to the health scenario in Muzaffrapur from a quantitative point of view, while they cannot by themselves provide a complete picture of the status of health in the district. However, it is useful to have outcome data to map the effectiveness of public investment in health. Further, when data pertaining to vital rates are analyzed in conjunction with demographic measures, such as sex ratio and mean age of marriage, they throw valuable light on gender dimension. Table below indicates the Health indicators of Muzaffrapur district with respect to Bihar and India as a whole. Table 3.1: Health Indicators Indicator Muzaffrapur Bihar India CBR 31.9 29.2 23.8 CDR NA 8.1 6 IMR 61 61 58 MMR 371 371 301 TFR 4.6 4 2.68 CPR 33 34.1 56.3 Complete Immunization 26.1 32.8 44

Sources: DLHS3, NFHS3, SRS2007

Muzaffarpur/DHAP 10-11/Page: 27

3.1.1. GAPS IN INFRASTRUCTURE:

BPHC Population 80000-120000

APHC Population 20000-30000

HSC Population 5000 First contact point with community Introduction: Health Sub Centre is very important part of entire Health System. It is first available Health facility nearby for the people in rural areas. We are trying to analyze the situations at present in accordance with Indian Public Health Standards. 1. Infrastructure for HSCs:

IPHS Norms:

Muzaffarpur/DHAP 10-11/Page: 28

i. Location of the centre: The location of the centre should be chosen that: a. It is not too close to an existing sub centre/ PHC b. As far as possible no person has to be travel more than 3 Km to reach the Sub centre c. The Sub Centre Village has some communication network (Road communication/Public Transport/Post Office/Telephone) d. Accommodation for the ANM/Male Health Worker will be available on rent in the village if necessary. For selection of village under the Sub Centre, approval of Panchayats as may be considered appropriate is to be obtained. ii. The minimum covered area of a Sub Centre along with residential Quarter for ANM will vary from 73.50 to 100.20 sq mts. depending on climatic conditions(hot and dry climate, hot and humid climate, warm and humid climate), land availability and with or without a labor room. A typical layout plan for Sub-Centre with ANM residence as per the RCH Phase-II National Program me implementation Plan with area/Space Specifications is given below Typical Layout of Sub- Centre with ANM Residence

Waiting Area : 3300mm x 2700mm Labour Room : 4050mm x 3300mm Clinic room : 3300mm x3300mm

Muzaffarpur/DHAP 10-11/Page: 29

Examination room : 1950mm x 3000mm Toilet : 1950mm x 1200mm Residential Accomodation : this should be made available to the Health workers with each one having 2 rooms, kitchen, bathroom and WC. Residential facility for one ANM is as follows which is contiguous with the main subcentre area. Room -1 (3300mm x 2700mm) Room-2(3300mm x 2700mm) Kitchen-1(1800mm x 2015mm) W.C.(1200mm x 900mm) Bath Room (1500mm x 1200mm) One ANM must stay in the Sub-Centre quarter and houses may taken on rent for the other/ANM/Male Health worker in the sub centre village. This idea is to ensure that at least one worker is available in the Sub-Centre village after the normal working hours. For specifications the “Guide to health facility design” issued under Reproductive and Child Health Programme(RCH-I and II) of Government of India, Ministry of Health and Family Welfare may be referred.

Health Sub Centers: Total population of the district as per 2001 census is 3746714. After considering 2.674 percent growth rate of the total population it comes around 4751108 (Decadal Growth Rate26.74). After considering projected population in 2008, the district needs altogether 749 HSCs to cater its whole population. At present Muzaffrapur has 473 established Health Sub Centers and 276 more Health sub centers are proposed to be formed. Again, out of 473 established HSCs, only 169 have their own buildings, 136 run in rented houses and the rest in other buildings. All these 169 HSCs need renovation work. All the above mentioned HSCs need equipments, drugs, furniture and stationeries.

Muzaffarpur/DHAP 10-11/Page: 30

Health Sub Centers: Sub Heads Gaps Issues Strategy Activities A. Out of 473 HSCs AStrengtheing of HSCs only 169 are having having own buildings Infrastructure own building

B. In existing 169 B.1.White washing of buildings 26 are in HSC buildings. running comparatively in B.2.Organize adolescent good condition, 6 girls for wall painting are in under and plantation./hire constriction ,one is local painter for colure In adequate very poor condition full painting of HSC facility in and one is walls. constructed constructed but not List out all services building and lack hand over to health which is provided at of community department. HSC level. On the wall. ownership

B.3.Gardening in HSC

Enhance premises by school visibility of HSC children. through C.No one building is hardware C.Mobilize running having running activity by the water facility from near water and electric help of by house if they have supply. community bore well and water participation storage facility and it . could be on monthly rental.

. D.1.Purchase of D. Lack of Operational Furniture Prioritizing equipments and problem in the equipment list ANM are reluctant availability of according to service to keep all equipment in delivery(for ANC equipments in HSC . constructed HSC /Family planning /Immunization/) E. Lack of appropriate D.2. Purchase of furniture equipments according to services Purchase one almiaria for keep all equipment safely and it could be keep in AWW / ASHA house. Muzaffarpur/DHAP 10-11/Page: 31

1.Non payment of 1.Non payment Regularizing 3B. Strengthening of rent of 136 HSCs for of rent rent payment HSCs running in rented more than three buildings. years B1. Estimation of backlog rent and facilitate the backlog payment within two months B2. Streamlining the payment of rent through untied fund from the month of April 09. B3.Purchase of Furniture as per need B4 Prioritizing the equipment list according to service delivery B5 Purchase of equipments as per need B6 Printing of formats and purchase of stationeries

1.The district still 1. Land 3C. Construction of needs 276 more Availability for new HSCs HSCs to be formed. new construction C1. Preparation of PHC wise priority list of HScs according to IPHS population and location norms of HScs 2. Constraint in C2. Community transfer of mobilization for constructed promoting land building donations at accessible locations. C3. Construction of New HSC buildings C4. Meeting with local PRI /CO/BDO/Police Inspector in smooth transfer of constructed HSC buildings. 1. Biannual facility Non participation of Monitoring Ensuring survey of HSCs through Community in community local NGOs as per IPHS monitoring Monitoring format

Muzaffarpur/DHAP 10-11/Page: 32

construction work 2. Regular monitoring of HSCs facilities through PHC level supervisors in IPHS format. 3. Monitoring of renovation/constructio n works through VHSC members/ Mothers committees/VECs/other s as implemented in Bihar Education Project. 4. Training of VHSC/Mothers committees/VECs/Othe rs on technical monitoring aspects of construction work. 5. Monthly Meeting of one representative of VHSC/Mothers committees on construction work 1. Lack of 1.Community Strengthening 1.Formation and community ownership of VHSCs, PRI strengthening of VHSCs, ownership in the Mothers committees

2.“Swasthya Kendra chalo abhiyan” to strengthen community ownership

3.Nukkad Nataks on Citizen’s charter of HSCs as per IPHS

4.Monthly meetings of VHSCs, Mothers committees

Services of HSCs:

As per IPHS norms a sub center provides interface with the community at the grass root level providing all the health care services. Of particular importance are the practices packages of services such as immunization, ANC, NC and PNC, prevention of malnutrition and common childhood diseases, family planning services and counseling. They also provide elementary drugs

Muzaffarpur/DHAP 10-11/Page: 33

for minor ailments such as ARI, diarrhea, fever, worm infestation etc. And carry out community need assessment. Besides the above the government implements several national health and family welfare programs which again are delivered through these frontline workers.

As per the DLHS-3( 2007-08)reports the percentage of full immunization(BCG, 3 doses each of DPT and Polio and measles) coverage(12-23 months) in the district is 56.4%. And BCG coverage of the district is 89.5%. 3 doses of polio vaccine is 72.5%, 3 doses of DPT vaccine is 71.4% and Measles Vaccine is 72.3%. The coverage of Vitamin A supplementation for the children 9 months to 35 months is 66.6 percent.

ANC in rural areas 60 40 3… 20 1 TT 0 DLHS-2 DLHS-3

Comparision of Immunisation Coverage in Rural Area 100 e g DLH… 50ta n DLH… e rc e0 P BCG DPT POLIOMEASLES F I Name of Antegen

Sub Heads Gaps Issues Strategy Activities Service Unutilized Operationalization Capacity building 1.Training of performance untied fund at of Untied fund. of account holder signatories on HSC level of untied fund operating Untied fund account, book keeping etc 2. Timely disbursement of untied fund for HSCs 3. Hiring a person at PHC level for managing accounts No ANC at HSC Improvement in Strengthening one 1. Identification of the level quality of services HSC per PHC for best HSC on service like ANC, NC and institutional delivery PNC, Immunization delivery in first 2.Listing of required Muzaffarpur/DHAP 10-11/Page: 34

quarter equipments and medicines as per IPHS norms 3. Purchasing/ indenting according to the list prepared 4.Honouring first delivered baby and ANM Only 14.2% PW Improvement in 1.Phase wise 1 Gap identification of registered in quality of services strengthening of 39 HSCs through first trimester like ANC, NC and 39 HSCs for facility survey PW with three PNC, Immunization Institutional 2. Eligible Couple ANCs is 15.1%, and family planning delivery and fix a Survey TT1 coverage is day for ANC as per 3. Ensuring supply of 35.4%, IPHS norms. contraceptives with Family Planning 2. Community three month’s buffer Status: focused family stock at HSCs. Any method- planning services 4. training of 43.6% AWW/ASHA on family Any modern planning methods and method-39.8% RTI/STI/HIV/AIDS No sterilization 5. Training of ANMs at HSC level on IUD insertion IUD insertion - 0.5% Pills-1.5% Condom-1.9% Total unmet need is 32.7%, for spacing-14.9 Lack of Training Training 1. Training to ANMs counseling on ANC, NC and PNC, services Immunization and other services. HSC unable to Integration of Implementation 1 Review of all disease implement disease control of disease control control programs HSC disease control programs at HSC programs through wise in existing programs level. HSC level Tuesday weekly meetings at PHC with form 6.( four to five HSC per week) 2.Strengthening ANMs for community based planning of all national disease control program 3. Reporting of

Muzaffarpur/DHAP 10-11/Page: 35

disease control activities through ANMs 4. Submission of reports of national programs by the supervisors duly signed by the respective ANMs. 80% of the HSC Absence of staffs Community 1. Submission of staffs do not monitoring absentees through PRI reside at place of posting Problem of Communication 1.Purchasing Life mobility during and safety saving jackets for all rainy season field staffs 2. Providing incentives to the ANMs during rainy season so that they can use local boats. Lack of Convergence Convergence 1. Fixed Saturday for convergence at meeting day of ANM, HSC level AWW, ASHA,LRG with VHSCs rotation wise at all villages of the respective HSC. 2. Monthly Video shows in all schools of the concerned HSC area schools on health, nutrition and sanitation issues. Lack of proper Reporting Strengthening of 1.Training to the field reporting from reporting system staffs in filling up form field 6, Form 2, Immunization report Lack of format, MCH appropriate registers, Muskan HMIS formats achievement reports and formate etc 2.Printing of adequate number of reporting formats and registers 3. Hiring consultants to develop software for reporting. Human Resource

Muzaffarpur/DHAP 10-11/Page: 36

450 428 418 401 400 Total No of HSC -473 350 300 APHC-43 250 223 195 Regular PHC-16 200 Contractual 150 RF-02 100 27 DH-01 50 0 Total NO of Post Total NO of ANM Total NO of Sanction In Position Vacant Post

Source: DHS Muzaffrapur Report

Sub Heads Gaps Issues Strategy Activities

Human Resource 1.Out of 473 Filling up the staff Staff recruitment 1.Selection and HSCs…….. don’t shortage recruitment of have either ANMs ….ANMs or Male worker, 2….. don’t have 2.Selection and ANMs recruitment of 3.Out of ….. …male workers sanctioned post of LHVs only ….. are placed 1.Out of ….. ANMs Untrained staffs Capacity building 1.Training need …. Are trained on Assessment of different services. HSC level staffs

2.Training of staffs on various services

The ANM training Training Strengthening of 1.Analyzing gaps school situated at ANM training with training Sadar Hospital school school campus, lacks adequate number 2.Deployment of of trainers, staffs required and facilities staffs/trainers

3.Hiring of trainers as per need

4. Preparation of annual training calendar issue wise as per guideline of Govt. of India.

Muzaffarpur/DHAP 10-11/Page: 37

5.Allocation of fund and operationalization of allocated fund

Drug kit 1.No drug kit as Indenting Strengthening of 1.Weekly meeting availability such for the HSCs reporting process of HSC staffs at as per IPHS and indenting PHC for norms.(KitA, Kit B, through form 6 promoting HSC drugs for delivery, staffs for regular drug for national and timely disease control submission of program (DDT, indents of drugs/ MDT, DOTs, vaccines DECs)and according to contraceptives, services and 2.No Drug kit for reports AWCs(@one kit per annum,) 3.No ASHA kit

Only need based Logistics 1.Ensuring supply emergency suuply of Kit A and Kit B Irregular supply of biannually drugs through Developing PHC wise logistics route map 2. Hiring vehicles for supply of drug kits through untied fund. 3.Developing three coloured indenting format for the HSC to PHC(First reminder-Green, Second reminder- Yellow, Third reminder-Red) Operationalization Couriers for 1 Hiring of vaccine and other couriers as per drugs supply need 2 Payment of

Muzaffarpur/DHAP 10-11/Page: 38

courier through ANMs account Phase wise 1.Purchasing of strengthening of cold chain APHCs for vaccine equipments as / drugs storage per IPHS norms 2. training of concerned staffs on cold chain maintenance and drug storage

Muzaffarpur/DHAP 10-11/Page: 39

Additional PHCs: There are 43 APHCs functioning in the district and 78 more are proposed to be established.

Additional PHC: Sub Heads Gaps Issues Strategy Activities nfrastructure 1.The district Lack of facilities/ Strengthening of 1.“Swasthya Kendra altogether need basic amenities in VHSCs, PRI and chalo abhiyan” to 116 APHCs but the constructed formation of RKS strengthen community there are 43 buildings ownership APHCs 2.Nukkad Nataks on functioning in Non payment of Citizen’s charter of the district and rent APHCs as per IPHS 78 more are Land Availability 3. Registration of RKS proposed to be for new 4.Monthly meetings of established. construction VHSCs, Mothers 2. Four more are committees and RKS required to be Constraint in Strengthening of A.Strengtheing of APHCs formed. transfer of Infrastructure and having own buildings 3.Out of 43 constructed operationalization A.1Rennovation of APHCs only 16 building . of construction APHCs buildings are having own works in Three A.2 Purchase of building Lack of phase Furniture 4.Existing 16 community A.3 Prioritizing the buildings are not ownership equipment list according properly to service delivery maintained A.4 Purchase of 5.Non payment equipments of rent of 14 A.5 Printing of formats APHCs for more and purchase of than three years stationeries Lack of B. Strengthening of equipments, APHCs running in rented Lack of buildings. appropriate B1. Estimation of backlog furniture rent and facilitate the Non availability backlog payment within of HMIS two months formats/registers B2. Streamlining the and stationeries payment of rent through untied fund/ RKS from t he month of April 09. B3.Purchase of Furniture as per need B4 Prioritizing the equipment list according to service delivery B5 Purchase of equipments as per need

Muzaffarpur/DHAP 10-11/Page: 40

B6 Printing of formats and purchase of stationeries 3C. Construction of new APHC buildings as standard layout of IPHS norms. C1. Preparation of PHC wise priority list of APHCs according to IPHS population and location norms of APHCs C2. Community mobilization for Monitoring promoting land donations at accessible locations. C3. Construction of New APHC buildings C4. Meeting with local PRI /CO/BDO/Police Inspector in smooth transfer of constructed APHCs buildings. 4 Biannual facility survey of APHCs through local NGOs as per IPHS format 4.1 Regular monitoring of APHCs facilities through PHC level supervisors in IPHS format. 4.2 Monitoring of renovation/construction works through VHSC members/ Mothers committees/VECs/others as implemented in Bihar Education Project. 4.3 Training of VHSC/Mothers committees/VECs/Others on technical monitoring aspects of construction work. 4.4 Monthly Meeting of one representative of VHSC/Mothers committees on Muzaffarpur/DHAP 10-11/Page: 41

construction work.

Human Out of 43 Filling up the staff Staff recruitment 1.Selection and Resource APHCs…….. don’t shortage recruitment of have doctors, Untrained staffs ….Doctors/Grade A …….. don’t have nurse/ANMs A grade nurse, 2.Selection and ….don,t have recruitment of …male ANMs, ……..don’ workers have pharmacist. 3. Sending back the staffs Out of ….. ANMs to their own APHCs. …. Are trained. The ANM Capacity building 1.Training need training school Assessment of APHC situated at Sadar level staffs Hospital campus, lacks adequate 2.Training of staffs on number of various services trainers, staffs 1. EmoC. Training to at and facilities Strengthening of least one doctor of each Out of ….. ANM training APHC Sanctioned post school of LHVs only ….. 2.Analyzing gaps with are placed training school Most of the APHC staffs are 3.Deployment of deputed to required staffs/trainers respective PHCS hence APHCS are 4.Hiring of trainers as per defunct need 5. Preparation of annual training calendar issue wise as per guideline of Govt of India.

6.Allocation of fund and operationalization of allocated fund

Drug kit No drug kit as Indenting Strengthening of 1.Weekly meeting of availability such for the reporting process APHC staffs at PHC for APHCs as per and indenting promoting APHC staffs IPHS Logistics through form 2 for regular and timely norms.(KitA, Kit and 6 submission of indents of B, drugs for drugs/ vaccines delivery, drug for Operationalization according to services and national disease reports control program 2.Ensuring supply of Kit A

Muzaffarpur/DHAP 10-11/Page: 42

(DDT, MDT, and Kit B biannually DOTs, DECs)and through Developing PHC contraceptives, wise logistics route map Only need based Couriers for 2.1 Hiring vehicles for emergency vaccine and other supply of drug kits suuply drugs supply through untied fund. Irregular supply 2.3 Developing three of drugs Phase wise coloured indenting strengthening of format for the APHC to APHCs for vaccine PHC(First reminder- / drugs storage Green, Second reminder- Yellow, Third reminder- Red) 3.1 Hiring of couriers as per need 3.2 Payment of courier through APHC account 4.1 Purchasing of cold chain equipments as per IPHS norms 4.2 training of concerned staffs on cold chain maintenance and drug storage Service RKS has not been Formation of RKS Capacity building 1.Training of signatories performance formed at any of Operationalization of account holder on operating Untied fund the APHC. of Untied fund. of untied fund /RKS account, book Unutilized untied keeping etc fund at APHC Improvement in Phase wise 2. Assigning PHC RKS level quality of services strengthening of accountant for No institutional like ANC, NC and 16 APHCs for supporting delivery at APHC PNC, Institutional operationalization of level Immunization and delivery and fix a APHC level accounts No OPD At any of other services as day for ANC as 2. Timely disbursement the APHC identified as gaps. per IPHS norms. of untied fund/ seed No inpatient money for APHCs RKS. facility available 3. 1 Gap identification of No ANC, NC and Integration of 16 APHCs through PNC and family disease control facility survey planning programs at APHC 2.strengtheing one APHC services. level. per PHC for institutional No lab facility delivery in first quarter No Ayush 3.Ownering first practitioner Family Planning Implementation delivered baby and ANM posted services of disease control 1 Review of all disease No rehabilitation programs through control programs APHC services Convergence APHC level where wise in existing Tuesday No safe MTP Operational issues APHC will work as weekly meetings at PHC service a resource center with form 6 Muzaffarpur/DHAP 10-11/Page: 43

No OT/ dressing for HSCs. At 2.Strengthening ANMs and Cataract present the same for community based operation is being done by planning of all national services. PHC only. disease control program Approx 80% of 3. Reporting of disease APHC staffs not control activities through reside at place of ANMs posting 4. Submission of reports Lack of of national programs by counseling the supervisors duly services signed by the respective Problem of ANMs. mobility during 5.Weekly meeting of the rainy season Community staffs of concerned HSCs Lack of focused Family ( as assigned to the convergence at Planning services APHC) APHC level 1.Eligible Couple Survey Operational 2. Ensuring supply of gaps: There is no contraceptives with link between three month’s buffer HSCs and APHCs stock at HSCs. and the same 3. training of way there is no AWW/ASHA on family link between planning methods and APHC and PHC RTI/STI/HIV/AIDS PPP 4. Training of ANMs on IUD insertion

1.Outsourcing services Convergence for Generator, fooding, cleanliness and Convergence ambulance

1. Fixed Saturday for meeting day of ANM, AWW, ASHA, LRG with VHSCs rotation wise at all villages of the respective HSC.

Muzaffarpur/DHAP 10-11/Page: 44

Primary Health centers: The district has 16 PHCs, two referral hospitals and a District hospital. The PHC of Sakra and referral hospital of Sakra is running in the same building. Primary Health Centers:(6 bedded) Indicators Gaps Issues Strategy Activities Infrastructure All PHCs are running with only Available facilities Upgradation of 1.Need based ( six bed facility. are not PHCs into 30 Service At present 16 PHC are working compatible with bedded facilities. delivery)Estimation with average 10 deliveries per the services of cost for day, 4 inpatient Kala-azar, 10 supposed to be upgradation of FP operation/emergency delivered at PHCs. PHCs operations and 120 OPD per 2. Preparation of day in each PHC. This huge Quality of services priority list of workload is not being interventions to addressed with only six beds deliver services. inadequate facility. Community ISO certification Identified the facility and participation. of selected PHCs 1. Selection of any equipments gap before in the district. two PHCs for ISO preparation of DHAP and certification in first almost 50-60% of facilities are phase. not adequate as per IPHS 2. Sending the norms.(List attached, recommendation Annexure..) for the The comparative analysis of certification with facility survey(08-09) and existing services DLHS3 facility survey(06-07) , Strengthening of and facility detail. the service availability BMU tremendously increased but 1. Ensuring regular the quality of services is still monthly meeting area of improvement. of RKS. Lack of equipments as per 2. Appointment of IPHS norms and also under Block Health utilized equipments. Managers, Lack of appropriate furniture Accountants in all Non availability of HMIS institutions.(16 formats/registers and PHCs, 2 Referals stationeries and Sadar Operation of RKS: hospital.) Lack in uniform process of RKS 3. Training to the operation. RKS signatories for Lack of community account operation. participation in the functioning 4. Trainings of of RKS. Ensuring BHM and Lack of facilities/ basic community accountants on amenities in the PHC buildings participation. their responsibilities.

1.Meeting with community

Muzaffarpur/DHAP 10-11/Page: 45

representatives on erecting boundary, beautification etc, 2. Meeting with local public representatives/ Strengthening of Social workers and Infrastructure and mobilizing them operationalization for donations to of construction RKS. works 3.Strengtheing of PHCs 1.Rennovation of PHCs 2. Purchase of Furniture 3. Prioritizing the equipment list according to service delivery Monitoring and IPHS norms. 4. Purchase of equipments 5. Printing of formats and purchase of stationeries 1. Biannual facility survey of PHCs through local NGOs as per IPHS format 2. Regular monitoring of PHC facilities through PHC level supervisors in IPHS format.

Muzaffarpur/DHAP 10-11/Page: 46

Human As per IPHS norms each PHC staff shortage Staff recruitment 1. Selection and Resource requires the following clinical Untrained staffs recruitment of staffs:(List attached) …..Doctors But the actual position is 2.Selection and General Surgeon 13/16 recruitment of Physician ---/16 …ANMs/ male Gynecologist 4/16 workers Pediatrics 4/16 3. 2.Selection and Anesthetist 2/16 recruitment of As per IPHS norms each PHC …paramedical/ requires the following para support staffs medical support:(List 4.Appointment of attached) Block Health But the actual position is Managers, Nurse midwife 68/152 Accountants in all Dresser…../16 institutions.(16 Pharmacist/compounders…/16 PHCs, 2 Referals Lab technician…./16 and Sadar Radiographer…./16 Capacity building hospital.) Ophthalmic assistant…/16 1.Training need Statistical assistants…./16 Assessment of PHC OT attendants…/16 level staffs Registration clerck…/16 2.Training of staffs Untrained doctors/ANMs in on various services emergency obstetrics care. 3.Trainings of BHM Only 14 BHMs and 11 and accountants accountants are placed at on their present. responsibilities. Demotivated BPMU staffs 4. Trainings of BHM on implementation of services/ various National program programs.

Drug kit Irregular supply of drugs Indenting Strengthening of 1.training of store availability because of lack of fund reporting process keepers on disbursement on time. and indenting invoicing of drugs Only … % essential drugs are Logistics through form 7 2.Implementing computerized rate contracted at state level . invoice system in Operationalization all PHCs 3.Fixing the Lack of fund for the responsibility on transportation of drugs from proper and timely district to blocks. Strengthening of indenting of There is no clarity on the drug logistic medicines( keeping guideline for need based drug system three months Muzaffarpur/DHAP 10-11/Page: 47

procurement and buffer stock) transportation. 4. Enlisting of equipments for safe storage of drugs. 5. Purchase of enlisted equipments. 6. Ensuring the availability of FIFO list of drugs with store keeper. 7. Orientation meetings on guidelines of RKS for operation. Service 1. Exessive load on PHC in Optimun Quality 1. Hiring of rented performance delivering all services i.e. 10 Utilization of improvement in houses from RKS delivery per day, 4 inpatient Human Resources residential facility fund for the Kala-azar, 10 FP of doctors/ staffs. residence of operation/emergency doctors and key operation and 120 OPD per staffs. day in each PHC. 2. Incentivizing 2. Total 42 seats of Regular doctors on their and 20 seats of contractual performances doctors in the district is especially on OPD, vacant. IPD, FP operations, 3. None of the PHC provides Kala-azar patient’s 24 hour blood transfusion treatment. services, however PHC sakra Epidemic 3. Revising Duty has been provided the outbreaks and rosters in such a equipments for blood storage Need based way that all posted unit. intervention in doctors are having 4.8 PHC does not have epidemic areas. at least 8 hrs laboratory facilities. assignments per 5. … Lab services provided by Recruitment day PPP services have fled away. 6. Only six PHC provides 1.Selection and adolescent sexual and appointment of reproductive health services. contractual 13.Health facility with AYUSH Proper and timely doctors and staffs services is not being provided information of 14. Referal outbreaks 1. Mapping of the a. No pick up facility for PW or areas having patients. Service Load history of b.BPL patients are not centered at PHC outbreaks disease exempted in paying fee of wise. ambulance. 2.Developing c. Lack of maintenance of micro plans to Muzaffarpur/DHAP 10-11/Page: 48 ambulances address epidemic d. Shortage of ambulances outbreaks 15. Quality of food, cleanliness 2.Assigning areas (toilets,Labour room, OT, to the MOs and wards etc) electricity facilities staffs are not satisfactory in any of 3.Motivating ASHA the PHC. on immediate 16. All PHCs have their own Availability of information of generator sets. AYUSH pathy. outbreaks 17. In serving emergency 4. Purchasing cases, there are maximum Strengthening of folding tents, beds chances of misbehave from Insecurity ( Staff equipments and and equipments the part of attendants, so and Properties) services and and medicines to staffs reluctant to handle increase in the organize camps in emergency cases. number of epidemic areas. ambulances. 1. Repairing of all 18. Several cases of theft of defunct instruments, computers, and Govts existing Ambulances submersible pumps etc at services like lab, x- Strengthening of 2. Repairing of PHCs. ray, generator, AYUSH services at PHcs gensets and 19. No guidance to the fooding and PHC level in the initiating their use. patients on the services cleanliness first level. 3. Hiring of available at PHCs. services. ambulances as per 20.Non friendly attitude of Confidence need. staffs towards the poor building measures 1. Appointment of patients in general and one AYUSH women are disadvantaged practitioner and group in particular. Yoga teacher in 21. Lack of inpatient facility for every PHC kala-azar patients. 22.Lack of councelling services Strengthening of 1.Insurance of all 23.Problem of mobility during the Govts existing properties and rainy season services like lab, staffs of PHC 24.Lack of convergence x-ray, generator, 2.Placing one TOP 25. Lack of timely reporting fooding and in every PHC and delay in data collection cleanliness services. 1. Assigning mothers committees of local BRC for food supply to the patients in govt’s approved rate. 2.Recruitment of Creating friendly lab technicians as environment required 3. Purchase of equipments/ Muzaffarpur/DHAP 10-11/Page: 49

instruments for strengthening lab. 4. Hiring of menial workers for cleanliness works. 1. Assigning LHV for counseling work 2. Wall writing on every section of the building denoting the facilities 3. Name plates of doctor 4. Displaying Roster of doctors with their details. 5. Gardening 6. Sitting arrangement for patients 7. Installation of LCD TV with cable connection 8.Installation of safe drinking water equipments/water HMIS and cooler, strengthening of 9.Installation of reporting process solar heater system and light with the help of BDO/Panchayat 9. Apron with name plates with every doctors 10. Presence of staffs with uniform and name plates. 1.Orientation of the staffs on indicators of reporting formats 2.Puchase of Laptops for DPMs and BHMs

Muzaffarpur/DHAP 10-11/Page: 50

District Hospital:

District Hospital Muzaffrapur: Indicators Gaps Issues Strategy Activities Infrastructure 1.There are 218 beds in the Lacks in Strengthening of 1. Purchase of 500 Sadar hospital which is not infrastructure infrastructure beds. adequate as per the 2. Repairing of beds. requirement. 3. Listing of required 2. At present District hospital equipments as per is working with average 25 IPHS norms and their deliveries per day, 30 purchase. inpatient Kala-azar, 20 FP 4. Listing of required operation/emergency furniture and their operations and 800 OPD per purchase. day. This huge workload is not 5. Simplifying process being addressed with only of RKS operation. 218 beds inadequate facility. 3. Lack of equipments as per 6. Computerization of IPHS norms and also under registration system utilized equipments. for the OPD/IPD 4.Lack of appropriate patients. furniture 5.Operation of RKS: 7.Construction of Delayed process of operation. shed for waiting Delay in disbursement of fund patients 6.Lack of facilities/ basic 8. Installation of 3 amenities in the PHC buildings Water cooler freezes 7.Huge workload in central as per requirement. registration unit 9. Installation of 8. No sitting arrangement for seven vapor lights as patients. per requirements. 10. No safe drinking water 10. Rennovation of facility. boundary wall and 11. Half of the hospital area gate. remains dark at night. 11. Construction of 12. Delivery room lacks beds, new Post mortem labor table, stretchers, and room with all equipments. facilities. 13. No proper gate and 12. Renovation of boundary wall. drainage system and 14. No proper post mortem internal road level room and equipments. upgradation. 15. Heavy water logging 13. Construction of during rainy season. enquiry counters at 16. Buildings for ICU, Causality the gate. ward are ready but due to 14. Hiring of lack of equipments, facilities ambulances. are not functional. 15. Construction of

Muzaffarpur/DHAP 10-11/Page: 51

17. No use of paying wards. new residential 18. No enquiry counters as buildings. such for the patients. 16. Hiring of rented 20. No residential facilities for houses from RKS fund doctors and staffs. for the residence of 21. No canteen facility doctors, BMU and key staffs. 16. Tender for canteen facility. 17. Sitting arrangement for patients 18. Installation of LCD TV with cable connection Human 1.Post of gynecologist and Lack in Staff Recruitment 1. Appointment of Resource pathologist are vacant. position gynecologist and 2.Post of one dresser, one OT pathologist on assistant and one ophthalmic contract basis. assistant are vacant. 2. Appointment of one dresser, one OT assistant and one ophthalmic assistant on contract basis.

Deputing staffs 1. Deputation of required staffs from field. Drug kit 1. Irregular supply of drugs Improper Supply 1.training of store availability because of lack of fund and logistics keepers on invoicing disbursement on time. of drugs 2. Only … % essential drugs 2.Implementing computerized invoice are rate contracted at state system level. 4. Enlisting of equipments for safe 3. There is no clarity on the storage of drugs. guideline for need based drug 5. Purchase of procurement and enlisted equipments. transportation. Lack in storage 6. Ensuring the 4. Lack of proper space, facility availability of FIFO list furniture and equipments for of drugs with store drug storage keeper. Service 1.Exessive load in delivering 1. Incentivizing performance all services doctors/ staffs on 2. Blood storage unit is their performances present but not utilized especially on OPD, 3.No 24hrs Lab facility IPD, FP operations,

Muzaffarpur/DHAP 10-11/Page: 52

4.Health facility with AYUSH Kala-azar patient’s services is not being provided treatment. 5. Referral 2. Purchase of a. No pick up facility for PW or equipments for Blood patients. storage unit, b. BPL patients are not 3. IEC on blood exempted in paying fee of storage unit. ambulance. 4. Revising Duty c. Lack of maintenance of rosters in such a way ambulances that all posted d. Shortage of ambulances doctors are having at 6. No guidance to the patients least 8 hrs on the services available at assignments per day DH. 7. Non friendly attitude of 5. Repairing of all staffs towards the poor defunct Ambulances patients in general and 6. Hiring of women are disadvantaged ambulances as per group in particular. need. 7. Appointment of one AYUSH practitioner and Yoga teacher 8. Purchase of equipments/ instruments for strengthening lab. 9. Wall writing on every section of the building denoting the facilities 10. Name plates of doctor 11. Displaying Roster of doctors with their details. 12. Gardening 13. Apron with name plates with every doctors 14. Presence of staffs with uniform and name plates.

Muzaffarpur/DHAP 10-11/Page: 53

MATERNAL HEALTH

Sl. No. Strategy Activity Input Breakup Budget

1 Operationalise FRUs 2 Operationalise 24x7 PHCs: 1. Upgradation of Labour Room including construction of labor room As per Annexure - 1 @ Rs. 500000X16 8000000 2. Recruitement of 3 @ Rs. Staff Nurses per PHC 3 X 16 = 48 7500X3*16*12 4320000 Building, 20 Beds, 20 Mattress, 20 Side Table, 20 Chairs, Baby coat-6, Pillow- 20, Bed Sheets & Pillow Cover 3. Maternal Ward - 7 sets 3 MTP services at health facilities @ Rs. 10000 per 1.Equipment for MTP phc for 16 phc 160000

2. Training of Doctors 2 doctors per phc 32000 3. Training of Staff Nurses 48000 4 RTI/STI services at health facilities 5 Operationalise Sub-centres 1. Recruitment of 1 Male Worker for HSC

@ Rs. 50000 per As per Annexture 4 of hsc for 473 existing IPHS Standard for and 110 newly 2. Furniture HSC created sub center 29150000

@ Rs. 50000 per As per Annexture 5 of hsc for 473 existing IPHS Standard for and 110 newly 3. Equipment HSC created sub center 29150000

@ Rs. 10000 per hsc for 473 existing and 110 newly 4. Safe Drinking Water Hand pump per HSC created sub center 5830000 As per Annexture 7 of @ Rs. 1000/- per 5. Registers for Sub IPHS Standard for sub center for 583 centers HSC HSC 583000

Muzaffarpur/DHAP 10-11/Page: 54

MATERNAL HEALTH

Sl. No. Strategy Activity Input Breakup Budget

118 Batch of 4 6. SBA Training for ANMs @ Rs. ANMs 43304/- per batch 5109872 473 X 1 @ Rs. 7. Sanitation Toilets 50000 23650000

6 Referral Transport 1. Ambulance Services Ambulance for 16 @ Rs. 500 p. m. to PHCs & APHCs PHCs & 43 APHCs per ambulance 10767500 2.IEC activity in village level

7 Institutional Deliveries 1. Strengthening PHC As per Operationalise for 24X7 24x7 PHCs

2. Using Bio Metric System for registration of payment of beneficiaries Approx 4000 delivery p.m. @ Rs. 3. Incentivie for 2000/- per beneficiaries beneficiary 96000000 4. C-Section in all PHCs Surgical instruments 240000

training of doctors 5. Canteen thorugh PPP

8 IMNCI Training Training of ANM & AWW - 36 Batches of 24 each For 864 ANM/AWW 3612924

Muzaffarpur/DHAP 10-11/Page: 55

Child Health

Strategy Activity Input Breakup Budget

1 Facility Based Newborn Care/FBNC 1. Neo Natal ICU incubater baby warmer suction a/c Ambu Bag oxygen cyllander 3400000

2 To increase fully immunised children from Strengthening of 57.4% (DLHS-3) to 80% Routine Immunisation Awareness through IEC/BCC 3 To increase Vitamine A Supplement in children of 9 to 35 months from 50.8% (DLHS- Strengthening of 3) to 90% Routine Immunisation Awareness through IEC/BCC 4 To increase number of children breastfed within one hour of birth from 15.5% (DLHS-3) Maternity ward where To 50% PNC will be done Appointment of MAMTA Awareness through IEC/BCC 5 Malnutrition NRC should be started in every PHC of district Orientation of ASHA on Malnutrition Awareness through IEC/BCC

Muzaffarpur/DHAP 10-11/Page: 56

Routine Immunisation

Strategy Activity Input Breakup Budget

1 RI strengthening project 1. Cold chain a. Proper Storage Maintenance Room b. Proper Wiring c. Voltage Stabilizer d. Vaccine Carrier e. Ice Pack f. Ice Box g. Deep Freezer h. ILR 2. Vehicle for Monitoring 3. Training of Cold Chain Handler 4. Continuous and regular vaccine supply a. Quarterly estimation b. Buffer stock should be maintained

Honorarium + TA for Participants @ Rs. 250 for 2 days of trainee ( ANM 585+ 210 to be 5. Health Workers selected, LHV- 15, Training on R/I Male HW - 107) 229250

Honorarium of 3 trainers @ Rs. 600 for 2 days training for 31 Batches 55800

Contingency @ Rs. 100/- per participant per day( incl of refreshment, venue, TV/LCD hiring and logistics 183400 Muzaffarpur/DHAP 10-11/Page: 57

Routine Immunisation

Strategy Activity Input Breakup Budget

6. Hep. A & B vaccine should be added in R/I 7. AMC should be at district level Printing of MCH cards, formats, Strengthening of Muskan registers, etc. Reporting System Stationeries 1000000 473 HSC @ Rs. Mobile Phone for HSC 2500 1182500

recharge @ Rs. 300/- p.m. per HSC 1702800 @ Rs. 5000/- p.m. 60000 2 R/I Data Center at district level

Muzaffarpur/DHAP 10-11/Page: 58

FAMILY PLANNING

Strategy Activity Input Breakup Budget

1 Terminal/Limiting Methods

1.1 Equipments for operation 2 Sets for each PHC + 5 Sets for Sadar Hospital 370000

1.2 Female Sterilisation camps 16000 through PHCs + Sadar & 5000 through Target 21000 Family accrediated Planning Operations incentives institution 23500000

1.3 NSV camps Target 2000 incentives 3000000

2 Spacing Methods

2.1 IUD IUD services at HSC level IUD insertion kit IUD - regular and continuous supply

2.3 OC Pills regular and continuous supply 2.4 Condoms regular and continuous supply

3 IEC & BCC Motivation of ASHA

Nukkad Natak

Hoarding board Advertisement through FM radio, television Muzaffarpur/DHAP 10-11/Page: 59

ASHA

Strategy Activity Input Breakup Budget

1 Selection & Training of ASHA 1. ASHA to be selected proportionate to current population 2. Training of all 5 Modules 3. BHM should be added in TOT 2 Strengthening of ASHA 1. ASHA should work as DOT provider at HSC level

3 Asha Divas Incentive of asha 2038800 Asha divas exps 407760

4 Procurement of ASHA Drug Kit 2000000

Muzaffarpur/DHAP 10-11/Page: 60

Institutional Strengthening

Strategy Activity Input Breakup Budget

1 Strngthening of PHC, APHC & REFERRAL

OPD of APHC, PHC & REFERRAL 1. Waiting Hall 2. Registration Counters

3. Doctor's cabin

4. OPD Room

5. Instruments - Stethoscope

BP Instrument

Weighing Machine

Thermometer 6. Lack of Man Power Doctors Paramedical Staff Registration Counter's Staff 7. Furniture Examination Table Writing Table Bench Stool Chair 8. Electrical Appliances Fan Light

9. Data operator for registration and drug distribution stock keeping PHC-16, SADAR- 2 10. Printed Registers Master register Doctor wise OPD register 11. Stationeries OPD slip

Muzaffarpur/DHAP 10-11/Page: 61

Institutional Strengthening

Strategy Activity Input Breakup Budget

PHC-14 APHC-43 Safe Drinking Water Boring Referral - 1 PHC-14 APHC-43 Over Head Tank Referral - 1 PHC-14 APHC-43 Motor Pump Referral - 1 Fittings PHC-16 APHC-43 Water Purifer Referral - 1 PHC-16 APHC-43 Water Cooler Referral - 1 PHC-14 X 2 APHC-43 X 1 Sanitation Toilets for male Referral - 1 X 3 PHC-14 X 2 APHC-43 X 1 Toilets for female Referral - 1 X 3

IPD Strengthening Indoor Ward / Building Furniture BHT, Discharge Stationeries slip, registers etc. PHC-14 APHC-43 Safe Drinking Water Over Head Tank Referral - 1 Fittings PHC-16 APHC-43 Water Purifer Referral - 1

Muzaffarpur/DHAP 10-11/Page: 62

Institutional Strengthening

Strategy Activity Input Breakup Budget

PHC-16 APHC-43 Water Cooler Referral - 1 PHC-14 X 2 Toilets with Bathroom APHC-43 X 1 Sanitation for male Referral - 1 X 3 PHC-14 X 2 Toilets with Bathroom APHC-43 X 1 for female Referral - 1 X 3

4 Beds, 4 Mattress, 4 Side Table, 4 Chairs, X 16 PHC Isolation Ward in Pillow- 4, Bed Sheets PHC & Pillow Cover - 7 sets Electrical Appliances Fan Light Curtain

Emergency room with Emergency in PHC casualty ward Stretcher Wheel Chair Security of staff at night - Night Armed Guard Duty room for Doctor and Staff 24 hrs Pathology and X-ray facility Oxygen Cyllander

2 Strngthening of Sadar Hospital OPD 1. Waiting Hall 2. Registration Counters - 2 3. Doctor's cabin

Muzaffarpur/DHAP 10-11/Page: 63

Institutional Strengthening

Strategy Activity Input Breakup Budget

4. Instruments - Stethoscope BP Instrument Weighing Machine Thermometer Specialist Doctors- Cardiac, Anesthetics, Neuro 6. Lack of Man Power surgen Paramedical Staff Registration Counter's Staff Sonologists

7. Furniture Examination Table Writing Table Bench Stool Chair 8. Electrical Appliances Fan Light

9. Data operator for registration and drug distribution stock keeping PHC-16, SADAR- 2 10. Printed Registers Master register Doctor wise OPD register 11. Stationeries OPD slip Safe Drinking Water Tube well 1 Over Head Tank 2 Motor Pump 2 Fittings Muzaffarpur/DHAP 10-11/Page: 64

Institutional Strengthening

Strategy Activity Input Breakup Budget

Water Purifer 10 Water Cooler 10 Sanitation Toilets for male 4 Toilets for female 4

IPD Strengthening chair,bed with mattress,side table, saline stand 300 pcs each side Furniture screen BHT, Discharge Stationeries slip, registers etc. Safe Drinking Water Over Head Tank 5 Fittings Water Purifer 50 Water Cooler 5 Toilets with Bathroom Sanitation for male 10 Toilets with Bathroom for female 10

Electrical Appliances Fan Light Curtain Oxygen pipe line . facility in all wards

ICU A/C Oxygen Cylinder Incubate Furniture Bed 10, chairs 10, Specialized Drugs ECG machine

Muzaffarpur/DHAP 10-11/Page: 65

Institutional Strengthening

Strategy Activity Input Breakup Budget

Suction Machine Heart Beat Monitor 10

Training of Para Medical Staff for ICU Handling

Emergency room with Emergency casualty ward Casualty OT Stretcher Wheel Chair Security of staff at night - Night Armed Guard Duty room for Doctor and Staff 24 hrs Pathology and X-ray facility Oxygen Cyllander

3 Blood Storage Centre Blood Storage Center should be functional Blood Bank for 6 proposed CHC refrigerator, incubator, and 1 Referral microscope etc.@ Rs. Hospital, Saraiya 125000 per set 875000 Strengthening of DMU Rs 30000 pm for 936000 DPM, Rs 26000 pm for DAM and Honourarium to Rs 22000pm for DPM, DAM and DA 4 DA Office Expenses Office Rent 4000*12 48000 Electricity/Gen. Set 4000*12 48000 Telephone, Fax 5000*12 60000 Copier Machine 60000 Muzaffarpur/DHAP 10-11/Page: 66

Institutional Strengthening

Strategy Activity Input Breakup Budget

Stationeries 10000*12 120000 Travel Expenses & 10000*12 120000 Fooding Vehicle hiring + Fuel 20000*12*2 480000 Charge Postage & Courier 3000*12 36000 Meeting Expenses 5000*12 60000 Miscellaneous 5000*12 60000 Honorarium of Data 5700*2*12 136800 Operator

Strainthening of BMU Rs 20000 pm for 6720000 BHM & Rs Honourarium to HM 15000 pm for 5 & Accountant Accountant Office Expenses

Telephone, Fax 1500*12*16 288000 Stationeries 5000*12*16 960000 Travel Expenses & 5000*12*16 960000 Fooding Vehicle hiring + Fuel 10000*12*16 1920000 Charge Postage & Courier 250*12*16 48000 Meeting Expenses 5000*12 60000 Miscellaneous 1000*12*16 192000 Honorarium of Data 5200*12*16 998400 Operator Untied fund for Sub-Centres @ Rs. 10000 per 6 annum 4730000 Muzaffarpur/DHAP 10-11/Page: 67

Institutional Strengthening

Strategy Activity Input Breakup Budget

Upgradation of CHCs to IPHS For 4 PHCs @ Rs. 7 20 lakh 8000000 District Action Plan @ Rs. 10000 per PHC for block level 8 meeting, etc. 160000 @ Rs. 50000 for district 50000 Corpus Grant to HMS/RKS @ Rs. 500000/- p.a. for block level and Rs. 1500000/- p.a. for district level 9 R.K.S. 8500000

10 Untied Grant for PHC/APHC 2950000

Rent for HSC 131 @ Rs. 500/- p.m. 11 for approx. 3 yrs. 2358000

Rent for APHC 8 @ Rs. 1200/- p.m. 12 for approx. 3 yrs. 345600

Muzaffarpur/DHAP 10-11/Page: 68

Kalazar

Strategy Activity Input Breakup Budget

1 Kalazar / Maleria

1.1 Strengthening the coverage of DDT Spray Special Module for ASHA Training on Kalazar Wages for SFW @ Rs. 113/- per day for 60 DDT Spray days 1010220 Wages for FW@ Rs. 92/- per day for 60 days 4112400 DDT Requirement {1,01,373 kg - 62,940 (available) } = 38,433 k.g. Transportation 35000 Contingency 59600 Supervision 28000 Vehicle for PHC 630000 Vehicle for District 90000 Training of MO, SFW, FW 255377 1.2 Motivation of Patients @Rs. 5 lacs per PHC for 16 PHC and @ Rs. 10 lacs Loss of Wages for Sadar Hospital 9000000

1.3 Rapid Maleria Test Test should be conducted at PHC level Appointment of L.T.

TOTAL 15220597

Muzaffarpur/DHAP 10-11/Page: 69

T. B.

Strategy Activity Input Breakup Budget

Strengthening of T.B. Programme (Based on Planned Activities) Civil Works 245000 Laboratory materials 350000 Honorarium 40000 IEC/Publicity 193800 Equipment Maintenance 65000 Training 50000 Vehicle maintenance 284800 Vehicle hiring 205000 NGO/PP Support 260000 Miscellaneous 105000 Contractual Services 3009000 Printing 120000 Medical Colleges 382000 Procurement - Vehicles 400000 Procurement - Equipments 10000

TOTAL 5719600

Muzaffarpur/DHAP 10-11/Page: 70

Filaria

Strategy Activity Input Breakup Budget

1 Eradication of Filaria District Coordination MDA round Meeting 14473 IEC Activities 186015 Training of MO & Paramedical Staff 130740

Line listing of Lymphoedema and Hydrocele cases Mopping, Morbidity Management & Operational Cost for these activities, 103650 Night Blood Survey 54789 POL 49020 Training of Drug Distributors 469100 Honorarium of Drug Distributors 539700 Training of Supervisor 50400 Honorarium of Supervisor 75600 Regular and timely supply of Drug Hydrocell Operation to be started in each PHC Training of Doctors

Referral of patients suffering from Orientation of ASHA, elephantisis to ANM for motivating specialised centers patient for treatment. Awareness through IEC/BCC

1673487 Muzaffarpur/DHAP 10-11/Page: 71

Leprosy

Strategy Activity Input Budget

1 Awareness IEC on Leprosy Rs 6000 106000 generation per PHC in a year for 16 PHC & Rs. 10,000 for Sadar Staff Recruitment of staff Recruitment in contract basis Strengthen Orientation of MOs and staffs of Leprosy Health Care NA 0 Services

Case validation, to have check on wrong diagnosis and re registration NA 0

ASHA Training for Prompt and early detection of the cases to avoid deformity and disability, NA 0 Rs2000 per PHC & sadar Ulcer care foot ware reorientation training of medical & para medical staff. 34000 NA

Effective Coordination between Leprosy Mission Hospital and DLO Establishing Establishing Lab at district level Rs 200000 200000 Lab Rs 1000 12000 Recurring expenditure like reagents per month 2 Increasing Updation of master register NA 0 mobility RS 3000 Mobility support for DLO per month 36000 Rs 2000 Office expenses per month 24000

412000

Muzaffarpur/DHAP 10-11/Page: 72

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission

Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D} =E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons for Variance Reasonsfor Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at state level) atstate (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or > than>(< or planned) CB or received Budget Special efforts t efforts Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A RCH

A.1 MATERNAL HEALTH

A.1 1. Mater- nal Health

A.1.1 1.1Operationalise facilities (dissemination, monitoring & quality) (details of infrastructure & human resources, training, IEC / BCC, equipment, drug and supplies in relevant sections)

A.1.1.1 1.1.1 Operationalise Block PHCs/ CHCs/ SDHs/ DHs as FRUs

A.1.1.1.1 1.1.1 Operationalise FRUs (Diesel, 2 1 1 2 2 224000 448000 368000 34144 225856 333856 224000 448000 Service Maintenance Charge, Misc. & Other costs) 1.1.1.1 Operationalise Blood Storage units in FRU

Muzaffarpur/DHAP 10-11/Page: 73

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.1.1.2 1.1.2 Operationalise 24x7 PHCs 1 0 1 1 1 25000 25000 25000 0 0 25000 25000 25000 (Organise workshops on various aspects of operationalisation of 24x7 services at the facilities @ Rs. 25,000 / year / district)

A.1.1.3 MTP services at health facilities 0 0 0 0 0 0

A.1.1.4 RTI/STI srvices at health facilities 0 0 0 0 0 0

A.1.1.5 Operationalise Sub-centres 0 0 0 0 0 0

A.1.2 1.2 Referral Transport 0 0 0 0 0 0 A.1.2.1 1.2.1. To develop guidelines 0 0 0 0 0 0 regarding referral transport of the pregnant women and sick new born / children and dissemination of the same @ Rs. 50,000 for the state

A.1.2.2 1.2.2. Payment to Ambulances for 0 0 0 0 0 0 all PHCs @ Rs. 200 / case of pregnancy for Jehanabad district (Pilot basis)

A.1.3. 1.3. Integrated outreach RCH 0 0 0 0 0 0 services

Muzaffarpur/DHAP 10-11/Page: 74

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.1.3.1 1.3.1. RCH Outreach Camps in un- 123 0 123 123 30 31 31 31 200 24600 24600 0 0 24600 743 91389 served/ under-served areas

A.1.3.2. 1.3.2. 0 0 0 0 0 0 Monthly Village Health and Nutrition Days at AWW Centres

A.1.4 1.4. 0 0 0 0 0 0 Janani Evam Bal Suraksha Yojana/JBSY

A.1.4.1 1.4.1 477 0 477 500 125 125 125 125 500 238500 238500 0 49733 238500 500 250000 Home deliveries (500/-)

A.1.4.2 1.4.2 Institutional Deliveries 0 0 0 0 0 0

A.1.4.2.1 1.4.2.1 Rural (A) 44970 20980 23990 46000 11500 11500 11500 11500 2000 89940000 89939133 31500539 4500000 58438594 2000 92000000 Institutional deliveries (Rural) @ Rs.2000/- per delivery for 10.00 lakh deliveries

A.1.4.2.2 1.4.2.2 Urban (B) Institutional 8994 7191 1803 12000 3000 3000 3000 3000 1200 10792800 10793234 5571000 344561 5222234 1200 14400000 deliveries (Urban) @ Rs.1200/- per delivery for 2.00 lakh deliveries

Muzaffarpur/DHAP 10-11/Page: 75

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.1.4.2.3 265 417 -152 1000 250 250 250 250 1500 397500 397416 43600 0 353816 1500 1500000

1.4.2.3 Caesarean Deliveries (Facility Gynec, Anesth & paramedic) 10.3.1 Incentive for C- section(@1500/-(facility Gynec. Anesth. & paramedic)

A.1.4.3 1.4.3 Other Activities(JSY) 0 900468 900468 0 0 900468 1000000 1.4.3. Monitor quality and utilisation of services and Mobile Data Centre at HSC and APHC Level and State Supervisory Committee for Blood Storage Unit

Total (JSY) 0 0 0 0 0 0 A.1.5 1.5 Other strategies/activities 0 0 0 0 0 0

A.1.5.1 1.5.1 Maternal Death Audit 1.1.3 0 0 0 0 0 0 Survey on maternal and perinatal deaths by verbal autopsy method (in two districts) @ 850 per death

A.2 2. Child Health 0 0 0 0 0 0

Muzaffarpur/DHAP 10-11/Page: 76

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.2.1 2.1. Integrated Management of 0 0 0 0 0 0 Neonatal & Childhood Illness/IMNCI (Monitor progress against plan; follow up with training, procurement, review meetings etc) 2.1. IMNCI (details of training, drugs and supplies, under relevant sections) 2.1.1. Monitor progress against plan; follow up with training, procurement, review meetings etc

A.2.2 2.2 Facility Based Newborm 129 0 129 129 32 32 32 33 872 112488 112760 0 0 112760 872 112488 Care/FBNC in districts (Monitor progress against plan; follow up with training, procurement, view meeting etc.) 2.2.1. Implementation of FBNC activities in districts. (Monitor progress against plan; follow up with training, procurement, etc.)

A.2.3. 2.3 Home Based New born 0 0 0 0 0 0 care/HBNC

Muzaffarpur/DHAP 10-11/Page: 77

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.2.4 2.4 School Health Programme 2790 2790 9905 2495 6961741 6961741 626245 0 6335496 2495 24712975 (Details annexed)

A.2.5. 2.5 Infant and Young Child 0 0 0 0 0 0 Feeding/IYCF

A.2.6. 2.6 Care of sick children & severe 0 0 0 0 0 0 malnutrition

A.2.7. 2.7 Management of Diarrhoea, ARI 0 0 0 0 0 0 and Micro nutrient

A.3 3.Family Planning 0 0 0 0 0 0 A.3.1. 3.1.Terminal/Limiting Methods 0 0 0 0 0 0

A.3.1.1. 3.1.1. Dissemination of manuals on 1 0 1 2 1 0 0 0 25000 25000 25000 0 0 25000 25000 50000 sterilisation standards & quality assurance of sterilisation services

A.3.1.2 3.1.2 Female Sterilisationcamps 0 0 0 0 0 0

A.3.1.3 3.1.3 3.1.2.2. NSV camps (Organise 7 0 7 19 10 9 10000 70000 70000 0 0 70000 10000 190000 3.1.2.2. NSV camps in districts @Rs.10,000 x 500 camps)

Muzaffarpur/DHAP 10-11/Page: 78

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.3.1.4 3.1.4 Compensation for female 18106 1890 16216 25000 2500 2500 10000 10000 1000 18106000 18106000 1940509 615986 16165491 1000 25000000 sterilisation 3.1.2.3. Compensation for female sterilisation at PHC level in camp mode 3.1.2.1. Provide female sterilisation services on fixed days at health facilities in districts (Mini Lap)

A.3.1.5 3.1.5 Compensation for male 1030 16 1014 1000 100 100 400 400 1500 1545000 1545508 0 105873 1545508 1500 1500000 3.1.2.4 slerilisation 3.1.2.4. Compensation for NSV Acceptance @50000 cases x1500

A.3.1.6 3.1.6 Accreditation of private 3339 2173 1166 7000 500 500 2000 4000 1500 5008500 5008500 1780050 50000 3228450 1500 10500000 3.1.3.1 providers for sterilisation services 3.1.3.1 Compensation for sterilization done in Pvt.Accredited Hospitals (1.50 lakh cases)

A.3.2 3.2. Spacing Methods 0 0 0 0 0 0 0 A.3.2.1 3.2.1. IUD Camps 0 0 0 0 0 0 0 A.3.2.2 3.2.2 IUD services at health 8 0 8 16 4 4 4 4 10000 80000 81000 0 0 81000 10000 160000 facilites/compensation

Muzaffarpur/DHAP 10-11/Page: 79

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.3.2.3 Accreditation of private providers 0 0 0 0 0 0 0 for IUD insertion services

A.3.2.4 Social Marketing of contraceptives 0 0 0 0 0 0 0

A.3.2.5 3.2.5 3.2.2. Contraceptive Update 0 0 0 0 0 0 0 3.2.2. Seminars (Organise Contraceptive Update seminars for health providers (one at state level & 38 at district level) (Anticipated Participants-50-70)

A.3.3 3.3 POL for Family Planning for 500 0 0 168856 168856 0 10000 168856 0 200000 below sub-district facilities

A.3.4 3.4 Repair of Laproscopes (Rs. 0 0 0 0 0 0 0 5000 x 40 nos.)

A.3.5 3.5 Other strategies/activities 0 0 16604 16604 0 0 16604 0 25000 3.1.4. Monitor progress, quality and utilisation of services 3.5. Establishing Community Based Condom and OCP Distribution Centres (pilot in one district/1 PHC)

Muzaffarpur/DHAP 10-11/Page: 80

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.4 4. Adolescent Reproductive and 0 0 0 0 0 0 0 Sexual Health (ARSH)

(Details of training, IEC/BCC in 0 0 0 0 0 0 0 relevant sections)

A.4.1 Adolescent services at health 1 0 1 2 1 1 25000 25000 25000 0 0 25000 25000 50000 facilites. 4.1.1. Disseminate ARSH guidelines.4.1.2. Establishing ARSH Cells in Facilities 4.1.2.1. Developing a Model ARSH Cell for the facilities 4.1.2.2. Establishing ARSH Cell at Patna District Hospital 4.1.2.3. Establishing ARSH Cell is 50% PHCs of Patna District 4.2 Conducting ARSH Camps at all PHCs for a week (as ARSH Week) 4.2.2 Establishing Youth friendly health clinics in Urban Area/ Universities Campus / Market Place

A.4.2 4.2 Other strategies/activities 0 0 0 0 0 0 0

Muzaffarpur/DHAP 10-11/Page: 81

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.5 5. 0 0 0 0 0 0 0 Urban RCH

A.5.1 5.1. Urban RCH Services 0 0 0 0 0 0 0 (Development of Micro-plans for each urban area already mapped for delivery of RCH services, both outreach and facility based through private agencies/institutions/organisations- 50lakhs & Operationalising 20 UHCs through private clinics @540000/- pm

A.6 6 Tribal Health 0 0 0 0 0 0 0 A.6.1 Tribal RCH services 0 0 0 0 0 0 0 A.6.2 Other strategies/activities 0 0 0 0 0 0 0 A.7 7. Vulnerable Groups 0 0 0 0 0 0 0 0 0 0 0 0 0 0 A.7.1 7.1 Services for Vulnerable groups

0 0 0 0 0 0 0 A.7.1 7.1 Services for Vulnerable groups

0 0 0 0 0 0 0 A.7.2 7.2 Other strategies/activities

A.8 8. Innovations/PPP/NGO 0 0 0 0 0 0 0

Muzaffarpur/DHAP 10-11/Page: 82

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

10 0 10 12 3 3 3 3 25000 250000 251595 0 0 251595 25000 300000

8.1.PNDT and Sex Ratio 8.1.1. Orientation programme of PNDT activities, Workshop at State, District and Block Level (1+38+533) A.8.1 (amount Rs.50 Lakhs) 8.1.2 Monitoring at District level and Meetings of District level Committee (100 Lakhs)

0 0 0 0 0 0 0 A.8.2. Public Private Partnerships

A.8.3 NGO Programme 0 0 0 0 0 0 0 A.8.4 Other innovations (if any) 0 0 0 0 0 0 0 A.9 INFRASTRUCTURE & HR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 A.9.1 Contracutal Staff & Services

A.9.1.1 480 0 480 480 120 120 120 120 5000 2400000 2400000 0 0 2400000 5000 2400000 9.1.1 ANMs 10.1.1.2. Hiring of 1000 Retired ANMs or ANMs from other states for out reach services @ Rs. 5000 / month / ANM

A.9.1.2 2 0 2 2 2 234000 468000 468000 0 0 468000 234000 468000

9.1.2 Laboratory Technicians - payment @ Rs. 6500 per month for 3 persons in one unit = Rs. 234000

Muzaffarpur/DHAP 10-11/Page: 83

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.9.1.3 Staff Nurses 0 0 0 0 0 0 0

Muzaffarpur/DHAP 10-11/Page: 84

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.9.1.4 0 0 0 8682460 8682460 0 0 8682460 0 8682460

9.1.4 Doctors and Specialists (Anaesthetists, Paediatricians, Ob/Gyn, Surgeons, Physicians) Hiring Specialists 1.1.1.1 Operationalise Blood Storage units in FRU -Salary of Medical Officer - 1,82,40,000/-; 10.1.2.1. Empeanelling Gynaecologists for gynaecology OPD in under or un served areas @ Rs. 1000/- week x 52 weeks ; 10.1.2.3. Empanelling Gyaneocologists for PHCstoprovide OPD services @ Rs. 300/- weekx 52 weeks; 10.1.2.4 Hiring Anaesthetist positions @ Rs.1000 per case x 120000; 10.1.2.5. Hiring Paediatrician for facilities where there are vacant Paediatricians positions @ Rs. 35,000/- month (2 per district); 10.1.2.6 Hiring Gynaecologists for facilities that have vacant positions @ Rs. 650 per case x 75000 cases

Muzaffarpur/DHAP 10-11/Page: 85

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.9.1.5 171 0 171 171 1200 205200 205376 0 0 205376 1200 205200

Other contractual Staff 9.1 Fast- Track Training Cell in SIHFW 9.2 Filling Vacant Position at SIHFW/Hiring Consultant at SIHFW 10.1.1 Honorarium of Voluntary Workers @ of 1200/- PA x 3106 No.

A.9.1.6 3532 3532 0 4700 4200 14834400 14836877 9489200 8529881 5347677 4200 19740000

Incentive/Awards etc. 8.2.1 Incentive for ASHA per AWW center (80000x200 per month) and Incentive toANMs per Aganwari Centre under Muskan Programme (@80000 x Rs.150 Per Month

A.9.2 0 0 0 0 0 0 0 9.2. Major civil works (new construction/extension/addition)

A.9.2.1 0 0 0 0 0 0 0 9.2.1 Major Civil works for operationalisation of FRUS A.9.2.2 0 0 0 0 0 0 0 9.2.2 Major Civil works for operationalisation of 24 hour services at PHCs

A.9.3 9.3 Minor Civil Works 0 0 0 0 0 0 0

Muzaffarpur/DHAP 10-11/Page: 86

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.9.3.1 2 1 1 2 50000 100000 100000 45500 0 54500 50000 100000

9.3.1 Minor civil works for operationalisation of FRUs 10.4.1 Facility improvement for establishing New Born Centres at 76 FRUs across the state - @ Rs. 50,000 / per FRU

A.9.3.2 14 14 0 15 4 2 4 5 25000 350000 350000 9000 62000 341000 25000 375000

9.3.2 Minor civil works for operationalisation of 24 hour services at PHCs 10.4.2. Facility improvement for establishing New Born Centres at PHCs across the state - @ Rs. 25,000 / per PHC

A.9.4 9.4 Operationalise IMEPat health 0 0 0 0 0 0 0 facilites A.9.5 9.5 Other Activities 0 0 0 0 0 0 0 A.10 10. Institutional Strengthening 0 0 0 0 0 0 0

A.10.1 10.1 Human Resource Development 0 0 0 0 0 0 0

A.10.2 10.2 Logistics 0 0 0 0 0 0 0 management/improvement

Muzaffarpur/DHAP 10-11/Page: 87

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.10.3 10.3 Monitoring Evaluation/HMIS 0 0 0 0 0 0 0 11.3 Monitoring & evaluation through monitoring cell at SIHFW

A.10.4 10.4 11.4 Sub-centre rent and 127 0 127 127 30000 3810000 3831300 0 0 3831300 6000 762000 contingencies @ 1770 no. x Rs.500/- x 60 months

A.10.5. 10.5. Other strategies/activities TA 0 0 0 0 0 0 0 & DA for the 30 days contact programme

A.11 11 Training 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11.1 Strengthening of Training A.11.1 Institutions 0 0 0 0 0 0 0 11.2 Development of training A.11.2 packages 0 0 0 0 0 0 0 A.11.3 11.3 Maternal Health Training

Muzaffarpur/DHAP 10-11/Page: 88

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

21 6 15 20 5 5 5 5 59000 1239000 1257600 125000 27412 1132600 59000 1180000

11.3.1 Skilled Birth Attendance /SBA 12.1.2 Skilled Attendance at Birth / SBA--Two days Reorientation of the existing trainers in Batches 12.1.3 Strengthening of existing SBA A.11.3.1 Training Centres 12.1.4 Setting up of additional SBA Training Centre- one per district 12.1.5 Training of Staff Nurses in SBA (batches of four) 12.1.6 Training of ANMs / LHVs in SBA (Batch size of four) 20 batches x 38 districts x Rs.59,000/-

0 0 0 0 0 0 0 EmOC Training 12.1.3 EmOc A.11.3.2 Training of (Medical Officers in EmOC (batchsize is 8 )

0 0 0 0 0 0 0 11.3.3 Life Saving Anaesthesia Skills training 12.1.5 Training of A.11.3.3 Medical Officers in Life Saving Anaesthesia Skills (LSAS)

Muzaffarpur/DHAP 10-11/Page: 89

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

1 0 1 1 1 25000 25000 25000 0 0 25000 25000 25000 11.3.4 MTP Training 12.1.6.1 Training of nurses/ A.11.3.4 ANMs in safe abortion 12.1.8 Training of Medical Officers in safe abortion

0 0 0 1 1 50000 0 0 0 0 0 50000 50000 Training of Medical Officers in safe

abortion 0 0 0 1 1 0 0 0 0 52050 52050 11.3.5 RTI/STI Training - Medical A.11.3.5 officers ANM/Staff Nurse 0 0 0 1 1 0 0 0 0 44850 44850 0 0 0 0 0 0 0 A.11.3.6 Dai Training

0 0 0 0 0 0 0 A.11.3.7 Other MH Training

A.11.4 IMEP Training 0 0 0 0 0 0 0 A.11.5 11.5 Child Health Training 0 0 0 0 0 0 0 0 0 0 0 0 0 0

11.5.1 IMNCI 12.2.1.1. TOT on IMNCI for Health and ICDS worker 12.2.1.2. IMNCI Training for Medical Officers (Physician) 12.2.1.3. A.11.5.1 IMNCI Training for all health workers 12.2.1.4. IMNCI Training for ANMs / LHVs/ AWWs 12.2.1.6 Followup training (HEs,LHVs)

Muzaffarpur/DHAP 10-11/Page: 90

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

Physician training 5 0 5 5 1 1 1 2 164105 820525 725325 0 0 725325 164105 820525 IMNCI TOT' 5 1 4 5 1 1 1 2 153200 766000 766000 145000 8200 621000 153200 766000 IMNCI for Health Worker 60 30 30 60 15 15 15 15 113900 6834000 6834000 2384474 156707 4449526 113900 6834000 IMNCI Follow up 0 0 30 10 10 10 91100 0 0 0 0 0 91100 2733000 0 0 0 0 0 0 0 11.5.2 Facility Based Newborn Care A.11.5.2 12.2.2.1 SNCU Training 12.2.2.2.NSU (TOT)

SNCU Training 0 0 0 1 1 92000 0 0 0 0 0 92000 92000 NSU (TOT) 0 0 0 1 1 51750 0 0 0 0 0 51750 51750 0 0 0 0 0 0 0 A.11.5.3 11.5.3 Home Based Newborn Care

0 0 0 0 0 0 0 11.5.4 Care of Sick Children and A.11.5.4 severe malnutrition

11.5.5 Other CH Training (Pl. 0 0 0 0 0 0 0 A.11.5.5 Specify) 0 0 0 0 0 0 0 A.11.6 11.6 Family Planning Training

0 0 0 0 0 0 0 12.6.1 Laproscopic Sterilisation A.11.6.1 Training 0 0 0 4 1 1 1 1 28000 0 0 0 0 0 28000 112000 11.6.2 Minilap Training12.3.2.1. Minilap training for medical A.11.6.2 officers/staff nurses (batch size of 4)

Muzaffarpur/DHAP 10-11/Page: 91

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

0 0 0 0 0 0 0 11.6.3 NSV Training 12.3.3 Non- A.11.6.3 Scalpel Vasectomy (NSV) Training

0 0 0 0 0 0 0

11.6.4 IUD InsertionTraining 12.3.4 IUD Insertion (details in Annexure) 12.3.4.1 State level (TOT for the A.11.6.4 districts) 12.3.4.2 District level training (one district total ) 12.3.4.3 PHC level training (for one district only)

0 0 0 0 0 0 0 A.11.6.5 Contraceptive Update Training

0 0 0 0 0 0 0 A.11.6.6 Other FP Training

0 0 0 1 1 8350 0 0 0 0 0 8350 8350

11.7 ARSH Training 12.4.1 ARSH training for medical officers 12.4.3 One Day ARSH Orientation by the A.11.7 MOs of 25% ANMs 12.4.4 One Day ARSH Orientation of PRI by the MOs of50% ANMs

11.8 Programme Management 0 0 0 0 0 0 0 A.11.8 Training

Muzaffarpur/DHAP 10-11/Page: 92

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

0 0 0 0 0 0 0

11.8.1 SPMU Training 12.5.4 State PMU to be trained/attend workshops in various areas like HR, A.11.8.1 Procurement & Logistics, PPP, FRU review and/or undertake study of various programmes in one good and one poor performing districts

11.8.2 DPMU Training 12.5.1 1 0 1 1 1 158000 158000 158000 0 0 158000 158000 158000 Training of DPMU staff @ 38 x Rs.10,00012.5.2. Training of SHSB/DAM/BHM on accounts at Head Quarter level @ 6x1500x12=1,08,000/- + DAM=38x1500x4 + BHM=538x1500x4 12.5.3 Training for ASHA Help Desk to DPMs (38), Block level organisers (533) and A.11.8.2 MOICs (533), @ 1104 x 1000/-

A.11.9 Other Training 0 0 0 0 0 0 0

Muzaffarpur/DHAP 10-11/Page: 93

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

11.9.1 Continuing Medical & 0 0 0 0 0 0 0 Nursing Education 11.2 Training of 20 (for total state) regular Government doctors in Public Health at Public Health Institute, Gujarat or at Wardha institute or Vellore institute to increase their A.11.9.1 administrative skills @ Rs.50,000/-

A.12 12. BCC/IEC (for NRHM Part A, B & 0 0 0 0 0 0 0 C)

A.12.1 12.1 Strengthening of BCC/IEC 0 0 0 0 0 0 0 Bureaus (State and District Levels)

A.12.2 12.2 Development of State BCC/IEC 1 0 1 1 1 0 25000 25000 25000 0 0 25000 25000 25000 strategy 13.3 Concept and material development workshops by State BCC/IEC Cell 13.8 Establishment cost of the State BCC/IEC Cell 13.10 Technical support at District level

A.12.3 12.3 Implementation of BCC/IEC 0 0 0 0 0 0 0 stretegy

Muzaffarpur/DHAP 10-11/Page: 94

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.12.3.1 12.3.1 BCC/IEC activities for MH 0 0 0 0 0 0 0

A.12.3.2 BCC/IEC activities for CH 0 0 0 0 0 0 0

A.12.3.3 12.3.3 BCC/IEC activities for FP 0 0 0 0 0 0 0

A.12.3.4 12.3.4 BCC/IEC activities for ARSH 0 0 0 0 0 0 0

Muzaffarpur/DHAP 10-11/Page: 95

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.12.4 16 16 0 0 107375 1718000 1718000 90390 213700 1627610 107375 0

12.4 Other activities 13.4 State Level events 13.5 District Level events ( Radio, TV, AV, Human Media as per IEC strategy dissemination) 13.6 Printed material (posters, bulletin, success story reports, health calendar,Quarterly magazines & diaries etc) 13.7 Block level BCC interventions (Radio, kalajattha and for IEC strategy dissemination) 13.11 Media Advertisements on various health related days 13.12 Various advertisements/tender advertisements/EOIs in print media at State level 13.13 Developing Mobile Hoarding Vans and A V Van for State and District 13.14 Hiring an IEC Consultancy at state level for operationation of BCC Strategy. (@ Rs. 50000 x 1 x 12) 13.16 Implementation of specific interventions including innovations of BCC strategy/plans block level 13.17 Implementation of specific interventions including innovations of BCC strategy/plans District level (Rs. 5000 x 38 x 12) 13.18 Implementing need based IEC Activities in Urban Areas (Support Muzaffarpur/DHAP 10-11/Page: 96 for Organization of need based IEC Activities in Urban Areas) (Rs.50000 Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

for Blocks 0 15 4 4 4 3 100000 0 0 0 100000 1500000 for District 0 1 1 500000 0 0 0 500000 500000 Sub-total IEC/BCC 0 0 0 0 0 0 0 A.13 Procurement 0 0 0 0 0 0 0 A.13.1 13.1 Procurement of Equipment 0 0 0 0 0 0 0

A.13.1.1 13.1.1 Procurement of equipment 1 0 1 2 2 132895 132895 132895 0 0 132895 132895 265790 14.2. Equipments for EmOC services for identified facilities (PHCs, CHCs) @ Rs 1 Lac / facility / year (in two districts - kishanganj and jehanabad) 14.4. Equipments / instruments for Blood Storage Facility / Bank at facilities 14.6. Equipments / instruments, reagents for STI / RTI services @ Rs. 1 Lac per district per year

A.13.1.2 13.1.2 Procurement of equipment : 0 0 0 0 0 0 0 CH

A.13.1.3 13.1.3 Procurement of equipment : 0 0 0 0 0 0 0 FP

A.13.1.4 13.1.4 Procurement of equipment : 0 0 0 0 0 0 0 IMEP

Muzaffarpur/DHAP 10-11/Page: 97

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

A.13.2 13.2 Procurement of Drugs & 0 0 0 0 0 0 0 supplies

A.13.2.1 13.2.1 Drugs & Supplies for MH 0 0 0 0 0 0 0

A.13.2.2 13.2.2 Drugs & Supplies for CH 0 0 0 0 0 0 0

A.13.2.3 13.2.3 Drugs Supplies for FP 0 0 0 0 0 0 0

A.13.2.4 13.2.4 Supplies for IMEP 0 0 0 0 0 0 0

A.13.2.5 General drugs & supplies for health 0 0 0 0 0 0 0 facilities

A.14 14. Prog. Manag- 0 0 0 0 0 0 0 ement

Strengthening of State Society/SPMU 0 0 0 0 0 0 16.1. Strengthening of State society/State Programme Management Support Unit 16.1.1. Contractual Staff for SPMU recruited and in position 16.5.1. Last pay drawn – Pension = Approx exp of Rs.20,000/-PM @ 20,000x6x12 A.14.1

Muzaffarpur/DHAP 10-11/Page: 98

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

14.2 Strengthening of District 1 1 0 1 1 739200 739200 739184 396600 0 342584 813120 813120 Society/DPMU 16.2.1. Contractual Staff for DPMSU recruited and in A.14.2 position

14.3 Strengtheningof Financial 1 0 1 1 1 240000 240000 240000 0 0 240000 240000 240000 Management Systems 16.3.1.Training in accounting procedures 16.3.2. Audits 16.3.2.1. Audit of SHSB/ DHS by CA for 2009-10 16.4 Appointment of CA 16.4.1 At State level 16.4.2 At District level 16.5 Constitution of Internal Audit wing at SHSB A.14.3

Muzaffarpur/DHAP 10-11/Page: 99

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO STRATEGIES 2009-2010FY 2010-2011 FY 2009-2010 FY 2010-2011 FY Activities

E} = BP= E}

±

(A)} = D =(A)}

Output 2012 2012 Output Advance Advance Remarks Variance (X~Y) Variance utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x {Y utilised Budget Component Code (only at statelevel) at (only Code Component o overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome o Budgetary Source (other than NRHMsource) than (other BudgetarySource Budget Planned {X x (A)} = B =(A)}x {X Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or >than(< or planned) CB or received Budget Special effortst Special Budget Planned (including spill over amount) {(AP x A)x {(AP over amount) spill (including Planned Budget

1 2 3 5 6 8 9 11 12 8 13 15

Q1 Q2 Q3 Q4

14.4 Other activities (Programme 1 1 0 1 1 840000 840000 839344 521918 0 317426 840000 840000 management expenses,mobility support to state,district, block) 16.1.2. Provision of mobility support for SPMU staff @ 12 months x Rs.10.00 lakhs Updgration of SHSB Office 16.2.2.Provision of mobility support for DPMU staff @ 12 months x 38 districts x Rs.69945.17/-

A.14.4

Total Prog. Mgt. 0 0 0 0 0 0 0 A.15 Others/Untied Funds 0 0 0 0 0 0 0 Total RCH II Base Flexi Pool 0 0 0 0 0 0 0

Total JSY, Sterilisation and IUD 0 0 0 0 0 0 0 Compensation, and NSV Camps

Grand Total RCH II 0 0 0 0 0 0 0 179523737 179393276 54703169 14899909 124690107 222358947

Muzaffarpur/DHAP 10-11/Page: 100

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget for 2010 - 2011

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO 2009-2010 FY 20010-2011 FY 2009-2010FY 2010-2011FY Activities

E} = BP= E}

± x A) A)x

XB =(A)}x

Output 2012 2012 Output Advance Remarks riance (X~Y) riance Va utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons forVariance Reasons Tentative Unit Cost (A)Cost Unit Tentative (A)Cost Unit Tentative Budget utilised {Y x (A)} = D =(A)}x {Y utilised Budget Budget Planned { Planned Budget under or over underor Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or > than>(< or planned) C Bor received Budget Special efforts to overcome constraints (Process to be adopted) be adopted) to (Process constraints overcome effortsto Special Budget Planned (including spill over amount) {(AP over amount) spill (including Planned Budget

Q1 Q2 Q3 Q4

B Please Note: plan all possible activities you think necessary for your area to realistically operationalise each strategy. Consider during planning: Infrastructure, Human Resources- all specialist, Para medics etc, Infection control & Environmental Plan, Logistics Management, HMIS, Monitoring & evaluation, Training- PMU, Dai, others, BCC/ IEC, Procurement of equipments/ Drugs, Strengthening Societies, PMU, RKS, VHSC, AYUSH inputs, initiatives for quality management B.1 Decentrlisation

1.1

B.1.11 ASHA Support system at State level 0 0 0 0 0 0 0 1 0 1 1 1 48000 48000 36000 0 0 36000 48000 48000 B.1.12 ASHA Support System at District Level

16 0 16 16 16 150000 2400000 2850000 0 0 2850000 150000 2400000 B.1.13 ASHA Support System at Block Level

1827 1827 1827 1800 3288600 208080 0 0 208080 1800 3288600 B.1.14 ASHA Support System at Village Level

0 0 0 0 0 0 0 B.1.15 ASHA Trainings

3984 0 3984 4700 600 2390400 1047200 0 0 1047200 600 2820000 B.1.16 ASHA Drug Kit & Replenishment

B.1.17 Emergency Services of ASHA 0 0 0 300 2200 0 0 0 0 0 2200 660000 3984 0 3984 3984 725 2888400 2933350 0 0 2933350 725 2888400 B.1.18 Motivation of ASHA

0 0 0 26 1000 0 0 0 0 0 1000 26000 Capacity Building/Academic Support B.1.19 programme 0 0 0 0 0 0 0 B.1.2 ASHA Divas

Muzaffarpur/DHAP 10-11/Page: 101

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget for 2010 - 2011

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO 2009-2010 FY 20010-2011 FY 2009-2010FY 2010-2011FY Activities

E} = BP= E}

± x A)x

X x (A)} = B =X(A)}x

Output 2012 2012 Output Advance Remarks riance (X~Y) riance Va utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons for Variance for Reasons Tentative Unit Cost (A) (A) Cost Unit Tentative (A) Cost Unit Tentative Budget utilised {Y x (A)} = D =(A)}x {Y utilised Budget Budget Planned { Planned Budget under or over or under Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or > than> or (

Q1 Q2 Q3 Q4

B

Please Note: plan all possible activities you think necessary for your area to realistically operationalise each strategy. Consider during planning: Infrastructure, Human Resources- all specialist, Para medics etc, Infection control & Environmental Plan, Logistics Management, HMIS, Monitoring & evaluation, Training- PMU, Dai, others, BCC/ IEC, Procurement of equipments/ Drugs, Strengthening Societies, PMU, RKS, VHSC, AYUSH inputs, initiatives for quality management 3984 3256 728 4700 1380 5497920 3680640 587070 452235 3093570 1380 6486000 ASHA Divas

Prize 0 0 0 16 2000 0 0 0 0 0 2000 32000 Identity Card 3984 0 3984 4700 20 79680 79680 0 0 79680 20 94000 Untied Fund for Health Sub Center, 0 0 0 0 0 0 0 B.1.21 Additional Primary Health Center and Primary Health Center for HSC 473 473 0 722 10000 4730000 4730000 1079728 3505796 3650272 10000 7220000 Orientation @ phc level 15 15 0 16 3000 45000 45000 45000 3000 48000 Orientation @ district level 1 1 0 1 2000 2000 2000 2000 2000 2000 Review meeting @ district on quarterly 4 0 4 4 10000 40000 40000 40000 10000 40000

basis 58 58 0 137 25000 1450000 1450000 114359 1057601 1335641 25000 3425000 for PHC/APHC 1730 600 1130 1827 10000 17300000 17297500 0 9135000 17297500 10000 18270000 B.1.22 Village Health and Sanitation Committee 0 0 0 16 2500 0 0 0 0 0 2500 40000 Orientation @ phc level 15 15 0 16 100000 1500000 2000000 300000 247756 1700000 100000 1600000 B.1.23 Rogi Kalyan Samiti - PHC

B.1.24 Orientation of member RKS@ phc level 0 0 0 16 2500 0 0 0 0 0 2500 40000 RKS - Sadar Hospital 1 1 0 1 500000 500000 500000 99369 25631 400631 500000 500000 B.2 Infrastrure Strengthening 0 0 0 0 0 0 0 B.2.1 Construction of HSCs ( 315 No.) 8 0 8 20 950000 7600000 7600000 0 0 7600000 950000 19000000 B.2.2 Construction of PHCS 0 0 0 0 0 0 0 0 0 construcion of residetial quarters of old 1 0 1 5 3000000 3000000 3000000 0 0 3000000 3000000 15000000 B.2.2.1 APHC for staff nurse Construction of building of APHCs where 1 0 1 11 5315000 5315000 5315000 0 0 5315000 5315000 58465000 B.2.2.2 land is available Up gradation of CHCs as per IPHS 6 0 6 10 4000000 24000000 24000000 0 0 24000000 4000000 40000000 B.2.3 standards Muzaffarpur/DHAP 10-11/Page: 102

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget for 2010 - 2011

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO 2009-2010 FY 20010-2011 FY 2009-2010FY 2010-2011FY Activities

E} = BP= E}

± x A)x

X x (A)} = B =X(A)}x

Output 2012 2012 Output Advance Remarks riance (X~Y) riance Va utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons for Variance for Reasons Tentative Unit Cost (A) (A) Cost Unit Tentative (A) Cost Unit Tentative Budget utilised {Y x (A)} = D =(A)}x {Y utilised Budget Budget Planned { Planned Budget under or over or under Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or > than> or (

Q1 Q2 Q3 Q4

B

Please Note: plan all possible activities you think necessary for your area to realistically operationalise each strategy. Consider during planning: Infrastructure, Human Resources- all specialist, Para medics etc, Infection control & Environmental Plan, Logistics Management, HMIS, Monitoring & evaluation, Training- PMU, Dai, others, BCC/ IEC, Procurement of equipments/ Drugs, Strengthening Societies, PMU, RKS, VHSC, AYUSH inputs, initiatives for quality management Infrastructure and service improvement 0 0 0 0 0 0 0 B.2.4 as per IPHS in 48 (DH & SDH) hospitals for accreditation or ISO : 9000 certification B.2.5 Upgradation of ANM Training Schools 1 1 0 1 5000000 5000000 5000000 0 450000 5000000 5000000 5000000 Annual Maintenance Grant 15 15 0 16 100000 1500000 1500000 40210 379790 1459790 100000 1600000 B.2.6 for PHC for Sadar Hospital 1 1 0 1 500000 500000 500000 65000 60000 435000 500000 500000 B.3 TOTAL INFRASTRUCTURE strengthening 0 0 0 0 0 0 0 B.3 Contractual Manpower 0 0 0 0 0 0 0 B.3.1 A Incentive for PHC doctors & staffs 1 0 1 1 664065 664065 664065 0 0 664065 664065 664065 B.3.1 B Salaries for contractual Staff Nurses 136 68 68 152 90000 12240000 12259099 2602200 319550 9656899 90000 13680000 200 302 -102 302 72000 14400000 14400000 9350506 450841 5049494 96000 28992000 B.3.1.C Contract Salaries for ANMs 1 0 1 1 2138837 2138837 2138837 0 0 2138837 2138837 2138837 B.3.1. D Mobile facility for all health functionaries 15 15 0 16 528000 7920000 10320744 3228906 528814 7091838 530400 8486400 B.3.1. D Block Programme management Unit 1 0 1 1 738000 738000 738000 0 0 738000 738000 738000 B.3.4 Addl. Manpower for NRHM B.4 0 0 0 0 0 0 0 PPP Initiativs 1 1 0 1 1 492000 492000 492000 369000 0 123000 492000 492000 102-Ambulance service B.4.1 (state-806400) @537600 X 6 Distrrict 1 1 0 1 1 168000 168000 136000 56000 0 80000 168000 168000 B.4.2 1911- Doctor on Call & Samadhan

B.4.3 Addl. PHC management by NGOs 0 0 0 0 0 0 0 0 0 B.4.5 SHRC 0 0 0 0 0 0 0 17 0 17 17 86312 1467304 1467300 0 0 1467300 86312 1467304 Services of Hospital Waste Treatment and B.4.6 Disposal in all Government Health facilities up to PHC in Bihar (IMEP)

Dialysis unit in various Government 0 0 0 0 0 0 0 B.4.7 Hospitals of Bihar Muzaffarpur/DHAP 10-11/Page: 103

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget for 2010 - 2011

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO 2009-2010 FY 20010-2011 FY 2009-2010FY 2010-2011FY Activities

E} = BP= E}

± x A)x

X x (A)} = B =X(A)}x

Output 2012 2012 Output Advance Remarks riance (X~Y) riance Va utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons for Variance for Reasons Tentative Unit Cost (A) (A) Cost Unit Tentative (A) Cost Unit Tentative Budget utilised {Y x (A)} = D =(A)}x {Y utilised Budget Budget Planned { Planned Budget under or over or under Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or > than> or (

Q1 Q2 Q3 Q4

B

Please Note: plan all possible activities you think necessary for your area to realistically operationalise each strategy. Consider during planning: Infrastructure, Human Resources- all specialist, Para medics etc, Infection control & Environmental Plan, Logistics Management, HMIS, Monitoring & evaluation, Training- PMU, Dai, others, BCC/ IEC, Procurement of equipments/ Drugs, Strengthening Societies, PMU, RKS, VHSC, AYUSH inputs, initiatives for quality management Setting Up of Ultra-Modern Diagnostic 1 1 0 1 4800000 4800000 4800000 0 3000000 4800000 4800000 4800000 Centers in Regional Diagnostic Centers B.4.8 (RDCs) and all Government Medical College Hospitals of Bihar Providing Telemedicine Services in 0 0 0 0 0 0 0 B.4.9 Government Health Facilities Outsourcing of Pathology and Radiology 16 -16 17 660000 0 0 0 0 0 660000 11220000 B.4.10 Services from PHCs to DHs 1 0 1 1 1 5616000 4212000 4212000 0 0 4212000 5616000 5616000 B.4.11 Operationalising MMU

Monitoring and Evaluation (State District 0 0 0 0 0 0 0 B.4.14 & Block Data Centre) Data Operator's Honorarium @ phc & 16 16 0 17 62400 998400 1938000 0 468000 1938000 96000 1632000

sadar 0 0 0 2 0 0 0 96000 192000 Data Operator @ DHS for monitoring 2 2 0 2 66000 132000 132000 0 132000 96000 192000 Data Center @ DHS 0 1 0 0 0 120000 120000 Stationeries & Misc. 0 1 0 0 0 25000 25000 EPBAX System 0 1 0 0 0 20000 20000 Web Server maintenance 1 0 0 0 20000 20000 SMS Server 8 0 0 0 0 0 0 0 B.4.15 Generic Drug Shop 1 0 1 1 2467200 2467200 2467000 0 0 2467000 2467200 2467200 B.4.16 Nutritional Rehabilitation Centre

B.4.17 Hospital Maintenance 0 0 0 0 0 0 0 Providing Ward Management Services in 0 0 0 1 0 0 0 0 3000000 3000000 B.4.18 Government Hospitals 3000000/- B.4.19 Provision for HR Consultancy services 0 0 0 0 0 0 0 B.4.2 Advanced Life Saving Ambulance 0 0 0 1 0 0 0 989000 989000

Muzaffarpur/DHAP 10-11/Page: 104

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget for 2010 - 2011

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO 2009-2010 FY 20010-2011 FY 2009-2010FY 2010-2011FY Activities

E} = BP= E}

± x A)x

X x (A)} = B =X(A)}x

Output 2012 2012 Output Advance Remarks riance (X~Y) riance Va utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons for Variance for Reasons Tentative Unit Cost (A) (A) Cost Unit Tentative (A) Cost Unit Tentative Budget utilised {Y x (A)} = D =(A)}x {Y utilised Budget Budget Planned { Planned Budget under or over or under Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or > than> or (

Q1 Q2 Q3 Q4

B

Please Note: plan all possible activities you think necessary for your area to realistically operationalise each strategy. Consider during planning: Infrastructure, Human Resources- all specialist, Para medics etc, Infection control & Environmental Plan, Logistics Management, HMIS, Monitoring & evaluation, Training- PMU, Dai, others, BCC/ IEC, Procurement of equipments/ Drugs, Strengthening Societies, PMU, RKS, VHSC, AYUSH inputs, initiatives for quality management TOTAL PPP INITIATIVES 0 0 0 0 0 0 0 B.5 B.5 Prourement of supplies 0 0 0 0 0 0 0 Delivery kits at the HSC/ANM/ASHA 2566 0 2566 5500 25 64150 64142 0 0 64142 25 137500 B.5.1 (no.200000 x Rs.25/-) SBA Drug kits with SBA-ANMs/ Nurses etc 1104 0 1104 1104 245 270480 270464 0 0 270464 245 270480 B.5.2 (no.50000 /38x Rs.245/-) 1 0 1 2 25000 25000 25000 0 0 25000 25000 50000 Availability of Sanitary Napkins at Govt. B.5.3 Health Facilities @25000/district/year 390 0 390 780 4522 1763580 1763640 0 0 1763640 9000 7020000 B.5.4 Procurement of beds for PHCs to DHs

TOTAL PROCUREMENT OF SUPPLIES 0 0 0 0 0 0 0 B.6 Procurement of Drugs 0 0 0 0 0 0 0 Cost of IFA for Pregnant & Lactating 9611855 0 9611855 9611855 0.11 1057304.05 1057304 0 0 1057304 0.11 1057304.05 B.6.1 mothers (Details annexed) Cost of IFA for (1-5) years children (Details 36141040 0 36141040 36141040 0.05 1807052 1807052 0 0 1807052 0.05 1807052 B.6.2 annexed) Cost of IFA for adolescent girls (Details 15070109 0 15070109 15070109 0.11 1657711.99 1657711.99 1657711.99 0.11 1657711.99 B.6.3 annexed) 0 0 0 0 0 0 0 TOTAL PROCUREMENT OF DRUGS Mobilisation & Management support for 0 0 0 0 0 0 0 B.7 Disaster Management 0 0 0 0 0 0 0 B.8 Health Management Information System

B.9 Strenthening of Cold Chain (infrastrcure 0 0 0 0 0 0 0 strengthening) B.9.1 Refurbishment of existing Warehouse for 0 0 0 0 0 0 0 R.I. as well as provision for hiring external storage space for (during Immunization Campaigns) Logistics at State HQ @Rs 1500000/- Muzaffarpur/DHAP 10-11/Page: 105

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget for 2010 - 2011

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO 2009-2010 FY 20010-2011 FY 2009-2010FY 2010-2011FY Activities

E} = BP= E}

± x A)x

X x (A)} = B =X(A)}x

Output 2012 2012 Output Advance Remarks riance (X~Y) riance Va utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons for Variance for Reasons Tentative Unit Cost (A) (A) Cost Unit Tentative (A) Cost Unit Tentative Budget utilised {Y x (A)} = D =(A)}x {Y utilised Budget Budget Planned { Planned Budget under or over or under Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or > than> or (

Q1 Q2 Q3 Q4

B

Please Note: plan all possible activities you think necessary for your area to realistically operationalise each strategy. Consider during planning: Infrastructure, Human Resources- all specialist, Para medics etc, Infection control & Environmental Plan, Logistics Management, HMIS, Monitoring & evaluation, Training- PMU, Dai, others, BCC/ IEC, Procurement of equipments/ Drugs, Strengthening Societies, PMU, RKS, VHSC, AYUSH inputs, initiatives for quality management B.9.2 Refurbishment of existing Cold chain 1 0 1 1 300000 300000 700000 0 0 700000 300000 300000 room for district stores in all districts with proper electrification,Earthing for electrical cold chain equipment and shelves and dry space for non elecrtical cold chain equipment and logistics @Rs 300000 Lakhs per district x 38 districts B.9.3 Earthing and wiring of existing Cold chain 19 15 4 16 10000 190000 190000 0 20000 190000 10000 160000 rooms in all PHCs @Rs 10000/- per PHC x 533 PHCs B.10 Preparation of Action Plan 0 0 0 0 0 0 0 Preparation of District Health Action Plan 1 1 0 1 100000 100000 100000 33000 0 67000 200000 200000 B.10.1 (Rs. 2 lakhs per district x 38) Preparation of State Health Action Plan @ 0 0 0 0 0 0 0 B.10.2 5 lakhs B.11 76 0 76 76 273600 20793600 20793600 0 0 20793600 273600 20793600 Mainstreaming Ayush under NRHM B.12 0 0 0 0 0 0 0 Continuing Medical & Nursing Education B.13 0 0 0 0 0 0 0 RCH Procurement of Equipments Procurement of Equipments/instruments 0 0 0 0 0 0 0 B.13.1 for Anesthesia B.13.2 Equipment for ICU 1 0 1 1 1705263 1705263 1705263 0 0 1705263 1705263 1705263 Equipments/instruments for ANC at 0 0 0 1 50000 0 0 0 0 0 50000 50000 B.13.3 Health Facility (Other than SubCentre) @ 50,000 per district per year B.13.4 Equipments for the Labour Room 16 0 16 16 223121 3569936 3569936 0 0 3569936 223121 3569936 B.13.5 Equipments for SNCU &NSU 17 0 17 0 131287 2231879 2231872 0 0 2231872 131287 0 B.13.5.A SNCU for 23districts unit cost of Rs. 0 0 0 1 0 0 0 0 2377258 2377258 2377258 B.13.5.B NSU for 530 PHCs unit cost of Rs. 139492 0 0 0 16 0 0 0 0 0 0 139492 2231872 B.13.6 NSV Kits 18 0 18 18 1100 19800 20000 0 0 20000 1100 19800 B.13.7 IUD insertion kit 1 0 1 17 15000 15000 15000 0 0 15000 15000 255000 Muzaffarpur/DHAP 10-11/Page: 106

Structured approaches for State/ District/ Block PIP planning National Rural Health Mission Strategy & Activity Plan with budget for 2010 - 2011

Name of the District: Muzaffarpur Sr. Activity Plan Budget Plan NO 2009-2010 FY 20010-2011 FY 2009-2010FY 2010-2011FY Activities

E} = BP= E}

± x A)x

X x (A)} = B =X(A)}x

Output 2012 2012 Output Advance Remarks riance (X~Y) riance Va utilised Budget {(B~D}=E Budget utilised Activity planned (X) planned Activity time line ofactivities line time Activity Executed (Y) Executed Activity - Reasons for Variance for Reasons Tentative Unit Cost (A) (A) Cost Unit Tentative (A) Cost Unit Tentative Budget utilised {Y x (A)} = D =(A)}x {Y utilised Budget Budget Planned { Planned Budget under or over or under Activity planned including previous yrs gap {Z+(X~Y)} =AP {Z+(X~Y)} gap yrs previous including planned Activity Budget received B or C (< or > than> or (

Q1 Q2 Q3 Q4

B

Please Note: plan all possible activities you think necessary for your area to realistically operationalise each strategy. Consider during planning: Infrastructure, Human Resources- all specialist, Para medics etc, Infection control & Environmental Plan, Logistics Management, HMIS, Monitoring & evaluation, Training- PMU, Dai, others, BCC/ IEC, Procurement of equipments/ Drugs, Strengthening Societies, PMU, RKS, VHSC, AYUSH inputs, initiatives for quality management B.13.8 Minilap sets 13 0 13 17 3000 39000 39474 0 0 39474 3000 51000 B.14 Additionalitiesfor NVBDCP under 0 0 0 0 0 0 0

NRHM 0 0 0 0 0 0 0 Total for Equipment Procurement

177522562 175989954 17925348 20101014 158064606 320326583

Muzaffarpur/DHAP 10-11/Page: 107